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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by capricorn on December 2, 2012, at 19:55:26
Saw pdoc two weeks ago. Asked me the usual questions ie 'are you hearing voices?' 'Any strange thoughts? 'Any thoughts of harming yourself?' and how i felt generally. I told her i felt indifferent but was not having strange thoughts etc.
I asked whether the injection could be increasing my anxiety and she said 'no,it should ease it'. Mentioned increasing dose but has left it up to me. I will have to tell them at the depot clinic if i want to try higher dose and they will get my card adjusted accordingly.
Hard to know what to do(unfortunately info is conflicting ie claims it helps with v claims it causes/worsens anxiety.) though i guess it was good of her to include me in the decision making process.
Posted by herpills on December 2, 2012, at 23:53:48
In reply to Whether to increase Risperdal Consta, posted by capricorn on December 2, 2012, at 19:55:26
I say continue with the same dose, and if you continue to have anxiety, that needs to be addressed. But if you are not hearing voices or having a major mood episode...I guess I wouldn't see the point in raising the dose of the Risperdal Consta...herpills
Posted by Christ_empowered on December 3, 2012, at 10:56:17
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by herpills on December 2, 2012, at 23:53:48
If its anxiety, I would see about an add on medication and/or supplements, self-help, that sort of thing. High dose antipsychotics *can* cause or worsen anxiety. I've had this happen before. Lowering the dose and maybe adding in something to address the anxiety might help in that situation.The point of antipsychotics is really just to prevent hospitalization and unfortunate behavior. I'd say keep the dose where it is now unless you feel you're at risk of a relapse. No point in using a strong antipsychotic to reduce anxiety when the potential risks are pretty severe (especially as the dose goes up).
BuSPar, maybe? Atarax? Neurontin? An antidepressant of some sort? You have options. Please talk to your doctor, and make it clear that you're looking to avoid an increase in the Risperdal dose and that you don't feel that you're at risk of a relapse.
Posted by Phillipa on December 3, 2012, at 12:14:39
In reply to Whether to increase Risperdal Consta, posted by capricorn on December 2, 2012, at 19:55:26
Capricorn what is your diagnosis? Has this happened before? Phillipa
Posted by capricorn on December 3, 2012, at 12:50:49
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by Phillipa on December 3, 2012, at 12:14:39
> Capricorn what is your diagnosis? Has this happened before? Phillipa
My diagnosis is personality disorder NOS (with psychotic symptoms). There was very brief talk of increasing the dose about 3 years ago.
Had not asked about the anxiety and depot until injection before last and at last pdoc appointment.
Both times told depot would reduce not increase anxiety.
Posted by ed_uk2010 on December 3, 2012, at 13:06:39
In reply to Re: Whether to increase Risperdal Consta, posted by capricorn on December 3, 2012, at 12:50:49
Hi there,
What dose of Consta are you on at the moment? And what sort of anxiety symptoms are you suffering?
Posted by capricorn on December 3, 2012, at 14:00:50
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by ed_uk2010 on December 3, 2012, at 13:06:39
> Hi there,
>
> What dose of Consta are you on at the moment? And what sort of anxiety symptoms are you suffering?
I'm on 25 mgs. Inner dread/nervous anticipation/occasional derealisation/occasional hyperventilation /going to urinate frequently/dry mouth/thinking i might have heart attack or stroke/nausea/
Posted by ed_uk2010 on December 3, 2012, at 14:50:59
In reply to Re: Whether to increase Risperdal Consta » ed_uk2010, posted by capricorn on December 3, 2012, at 14:00:50
>Inner dread/nervous anticipation/occasional derealisation/occasional hyperventilation /going to urinate frequently/dry mouth/thinking i might have heart attack or stroke/nausea.
It sounds awful. Have you experienced feelings like this before you started Consta, and how long have you been on Consta?
Posted by capricorn on December 3, 2012, at 16:11:48
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by ed_uk2010 on December 3, 2012, at 14:50:59
>
> It sounds awful. Have you experienced feelings like this before you started Consta, and how long have you been on Consta?
>
>
>
Been on Consts since May 2009. Had feelings before Consta so not seeing it so much as initial cause but ? anxiety is exacerbated by Consta.
Pdoc and nurse say 'no'. If not-then unfortunate coincidence?
Posted by ed_uk2010 on December 3, 2012, at 16:25:33
In reply to Re: Whether to increase Risperdal Consta, posted by capricorn on December 3, 2012, at 16:11:48
>anxiety is exacerbated by Consta....
Did you experience an exacerbation of anxiety during the first few months of treatment? If so, it would seem likely that Consta was the cause. If anxiety worsened later in treatment, it's less likely that Consta is the cause, especially since you've experienced anxiety prior to starting the medication.
An anxiety-like state called akathisia with extreme physical restlessness and pacing can be a side effect of antipsychotics. It usually starts very early in treatment. This does not sound anything like your symptoms though.
Posted by capricorn on December 3, 2012, at 16:43:10
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by ed_uk2010 on December 3, 2012, at 16:25:33
> >anxiety is exacerbated by Consta....
>
> Did you experience an exacerbation of anxiety during the first few months of treatment? If so, it would seem likely that Consta was the cause. If anxiety worsened later in treatment, it's less likely that Consta is the cause, especially since you've experienced anxiety prior to starting the medication.
>
> An anxiety-like state called akathisia with extreme physical restlessness and pacing can be a side effect of antipsychotics. It usually starts very early in treatment. This does not sound anything like your symptoms though.
>
>Hard to say when anxiety ramped up.Just know i had been on Consta a while before i considered a possible connection.
Posted by ed_uk2010 on December 3, 2012, at 17:08:26
In reply to Re: Whether to increase Risperdal Consta » ed_uk2010, posted by capricorn on December 3, 2012, at 16:43:10
>Hard to say when anxiety ramped up.Just know i had been on Consta a while before i considered a possible connection.
Oh I see. Are you on any other medication apart from Risperdal?
Also, are you on depot due to compliance issues?
Consta is difficult to titrate due to its slow release characteristics. If you want to find out what a higher dose of Risperdal would be like, it would be easier to stay on Consta 25mg and add a small additional dose of risperidone by mouth eg. 0.5mg-1mg/day initially. That way, if the higher dose doesn't suit you you can easily stop. If the higher dose is beneficial you can increase your depot to 37.5mg and gradually taper the oral risperidone. If your anxiety gets worse on a higher dose you will know that risperidone is a likely cause of your worsened anxiety. If your anxiety gets better on the other hand....
Posted by jono_in_adelaide on December 3, 2012, at 17:20:17
In reply to Whether to increase Risperdal Consta, posted by capricorn on December 2, 2012, at 19:55:26
For some (me included) risperidone effectively reduces anxiety, but for some people, it can increase it. It might be worth trying a benzo to see if that helps your anxiety (say Tranxene 15-30mg at bedtime)
Posted by capricorn on December 4, 2012, at 3:14:38
In reply to Re: Whether to increase Risperdal Consta » capricorn, posted by ed_uk2010 on December 3, 2012, at 17:08:26
> >Hard to say when anxiety ramped up.Just know i had been on Consta a while before i considered a possible connection.
>
> Oh I see. Are you on any other medication apart from Risperdal?
>
> Also, are you on depot due to compliance issues?
>
> Consta is difficult to titrate due to its slow release characteristics. If you want to find out what a higher dose of Risperdal would be like, it would be easier to stay on Consta 25mg and add a small additional dose of risperidone by mouth eg. 0.5mg-1mg/day initially. That way, if the higher dose doesn't suit you you can easily stop. If the higher dose is beneficial you can increase your depot to 37.5mg and gradually taper the oral risperidone. If your anxiety gets worse on a higher dose you will know that risperidone is a likely cause of your worsened anxiety. If your anxiety gets better on the other hand....
>
>Only on Consta. Went on it because had a bad track record of remembering to take oral meds.
Posted by novelagent on December 9, 2012, at 19:04:35
In reply to Whether to increase Risperdal Consta, posted by capricorn on December 2, 2012, at 19:55:26
Has your doctor not hear of Invega Sustenna, or do you enjoy the conversations with your injecting nurse so much, you don't want to switch to a once-monthly form? ;)
Anyhow, anxiety is a ridiculous reason to up your dose. For one thing, it doesn't reduce anxiety; it just is such a blunt drug, it seems like it would, and psychotics conflate hearing voices and paranoia with anxiety, so they'll report less "anxiety" when their mind is clearer. That doesn't translate to non-psychotic anxiety, however.
So it won't reduce your anxiety, but it will increase your lifetime risk of uncontrollable muscle movements, so there's that. If it were me, I'd rather deal with the side effects of klonopin than worrying about my face making uncontrollable grimacing movements, since I've had to deal with that in treatment-onset form, and it's not pleasant waiting for that to pass while in the bathroom of a pizza shop for 20 minutes... I couldn't imagine having that for life.
But some docs prefer putting you at risk for that over giving you klonopin. They're called clinic docs. They're saddistic and prescribe like they're reimbursed: poorly. I mean, they make you get a shot twice a month when there's a perfectly safe drug that titrates and has a steady state in 3 days instead of 6 weeks. I think that speaks for itself as to how good their judgment is.
This is the end of the thread.
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