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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 jjj on May 17, 2005, at 23:44:59
Hello.
I've have problems with hallucinations that I've been treating with risperdal. Things were pretty much under control and I was feeling a lot better, so I decided to try and lower my dose in the hopes that I could eventually get completely off the medicine.
After gradually reducing the dosable over a long period of time, I'm down to .25 mg from 2 mg now and my symptoms are really coming back. (hearing voices that keep me up at night). My pdoc mentioned that withdrawing from risperdal could actually increase the symptoms and that my brain would adjust to the lower dosage. He mentioned that patients taking risperdal for other problems (not psychotic related) would actually develop psychotic symptoms after stopping the medication.
I haven't noticed this problem before when lowering the dose, but it is coming down to the last little bit.
My experience has shown that increasing the dose makes the voices less severe and eventually they go away. Now that I'm lowering the dose I notice the opposite effect. Things are gradually getting worse.
I'm wondering if anyone else has experienced this backlash of symptoms when lowering their risperdal dose. I'm hoping that it is temporary, but I fear that I won't be able to stop taking this medicine.
anyways,
jjj
Posted by JACJ on May 17, 2005, at 23:44:59
In reply to risperdal withdrawl causing more symptoms, posted by jjj on May 17, 2005, at 10:03:23
"He mentioned that patients taking risperdal for other problems (not psychotic related) would actually develop psychotic symptoms after stopping the medication."
Did he say this would go away eventually?
Posted by SLS on May 17, 2005, at 23:44:59
In reply to risperdal withdrawl causing more symptoms, posted by jjj on May 17, 2005, at 10:03:23
> "He mentioned that patients taking risperdal for other problems (not psychotic related) would actually develop psychotic symptoms after stopping the medication."
>
> Did he say this would go away eventually?
>
I think it is perfectly reasonable to treat psychotic depression or bipolar disorder with dosages of Risperdal between 2.0-3.0mg. I don't quite understand the pressure to place you on a dosage below 1.0mg. It doesn't make sense to me. The return of psychotic symptoms is simply your illness breaking through an inadequate dosage of Risperdal. I would suggest either using a truly therapeutic dosage of Risperdal or cross over to another antipsychotic if you feel compelled to.I don't think the return of psychotic symptoms is a "rebound" psychosis from lowering your dosage of Risperdal that will eventually resolve on its own. You need more medication.
Sorry for the bad news. The truly great news is that you are treatable with drugs that are currently available. Don't neglect this gift.
- Scott
Posted by Phillipa on May 17, 2005, at 23:44:59
In reply to Re: risperdal withdrawl causing more symptoms » jjj, posted by SLS on May 17, 2005, at 12:38:01
Why does your pdoc want you to stop taking something that works for you? Fondly, Phillipa
Posted by jjj on May 17, 2005, at 23:44:59
In reply to Re: risperdal withdrawl causing more symptoms, posted by Phillipa on May 17, 2005, at 18:19:20
Actually, it was my idea to lower dosage, not my pdoc's. He believes that the symptoms will reduce over time at the lower dosage (basically that short term withdrawl of risperdal leads to a short term increase of psychotic symptoms, even in previously non-psychotic patients)
I'm having problems with side effects and wanted to see how well I'd do without the medication. I've also been in therapy and feel that I can deal with the symptoms better than I was able to in the past.
I was previously taking lots of medication and I've been successful at removing all of it except for the risperdal.
Previously I was convinced that what was happening was completely real. (i.e. there really was somebody in the next room screaming at me at 4:00 am, etc...) Now I understand that what I'm hearing are projections of my own thoughts and not some external entity.
Overall, I feel that I've been able to cope with my psychotic symptoms, at least lately. When they first started it was very alarming and definitely affected my functioning. Now I'm aware of what is happening and treat it as a annoyance. The symptoms happen, they can be pretty hurtful and definitely bring up emotions that I'd prefer not to deal with, but I can manage with it.
Lowering the dosage gradually has helped with that. at .5 mg for example, the symptoms returned occasionally, but were more of a minor annoyance. I think the effective dose depends on what your expectations are for the medication and vary depending on the person taking the medicine. If I wanted to completely remove all traces of the symptoms, then 2 mg does the trick. .5 mg is quite livable for me.
So, basically, I'm curious. My life was basically stable, so I decided to ask the question: Do I really need this medicine to manage my day to day life? Is it worth the health risk of taking it (obesity, possibility of diabetes, etc...)? I would like to have a choice in the matter about what I injest. I've become quite physically dependant on risperdal, can't sleep without it,etc... and that worries me a little bit. Perhaps it was a mistake, if things become unbearable I can always start up with it again.
I'm a little bit hopeful, I guess. Hopeful that somehow I have changed through therapy and other treatment. If all the symptoms come back when I stop the medication, then I really haven't made any progress, except for taking a pill every night.
Anyways, sorry for the long response, just trying to explain my position. Please, if a medicine is working for you, it is probably a good idea to stick with it. Don't let me dissuade anyone from treatment and definitely don't stop treatment without a doctor's supervision.
jjj
Posted by JACJ on May 18, 2005, at 6:38:15
In reply to Re: risperdal withdrawl causing more symptoms, posted by jjj on May 17, 2005, at 23:16:53
Hi JJJ,
I really feel for you. I know exactly what you are experiencing. I was on 13 drugs in 2.6 years. I wasn't on them all of the time but it was hell. I was a normal person wtih soem anxiety and depression and went on Wellbutrin and had a manic epidsode which lead to more drugging. I am a true victim of medical mistakes. I am still very bitter and angry but that doesn't do me any good. I am an advocate for those on AP's. I don't tell anyone what to do with their meds b/c that is their business. All I can do is voice my views b/c of my situation.I have researched alot about AP's. Ris. is a bad one, well they are all not good drugs but with time the brain and body heals. We are meant to heal. I came off a benzo and AP really fast due to a doctor telling me to. I suggest a really slow taper to reduce the w/d effects. Did you doctor say how long the short term psychosis would last? I still wonder how short term it is? My research is more about Tardive Dyskinesia.
I know w/d can last for some time. I have been off the AP for 13 months and still have w/d symptoms like anxiety and obsessive thoughts which I never had before the drugs. The anixety is something I can't explain. It is different from a normal anxiety epidsode. You can make it.
I would love to tell you not to stay on the meds but it is not ethical for me to do that nor is it my business. You have to do what is right for you and only you have the key to the truth. I know some people really need meds.
What does your doctor say about this? How long were you on Ris.?
JACJ
Posted by SLS on May 18, 2005, at 8:28:58
In reply to Re: risperdal withdrawl causing more symptoms, posted by jjj on May 17, 2005, at 23:16:53
Hi.
> Perhaps it was a mistake,
It is no mistake that you should want to live your life not being tethered to and dependent on medication. I would like to be healthy and free of medication as well. I understand your desire to experiment in order to determine your true treatment needs.
> if things become unbearable I can always start up with it again.
What condition are you diagnosed with?
Are you sure that you would be able to recognize a need for treatment once the psychosis becomes severe enough? For the few times that I have become manic (psychotically), no one was able to convince me that I needed help. It is good that you have someone close to you whose judgement you can trust.
> Actually, it was my idea to lower dosage, not my pdoc's. He believes that the symptoms will reduce over time at the lower dosage (basically that short term withdrawl of risperdal leads to a short term increase of psychotic symptoms, even in previously non-psychotic patients)
I did a quick literature search regarding antipsychotic discontinuation rebound psychosis. It seems that this occurs only if psychosis or a biological vulnerability was present prior to treatment. For example, certain medications used to treat Parkinsons Disease produce psychosis as a side effect, even though there had been no prior history of a psychotic disorder. Antipsychotics are frequently used to treat this side effect. If the antipsychotic is removed while the patient is still on the same Parkinsons medication, a rebound psychosis is possible wherein the psychotic symptoms are temporarily worse than before it was introduced. However, this is not an example of a rebound psychosis being produced where none had been there before. If someone using an AP only for sleep whom is otherwise healthy and has no risk factors for psychosis were to become psychotic upon the discontinuation of that AP, this would be an example of what your doctor had intimated.
In your case, a rebound psychosis is quite possible and might be worth waiting to see in what direction it goes. I hope that you use this time of experimentation to come to a conclusion one way or another, and that you don't find yourself in a vicious circle of compliance and non-compliance. You might want to journal your experiences so that you can reflect upon them in the future should this issue become prominent in your thoughts again.
Do what you gotta do to convince yourself. I myself have discontinued certain medications in the past to see if I really needed them or not. In your situation, I would not consider a negative outcome to be a mistake, but rather the results of a reasonable experiment.
If you respond well to Risperdal at dosages of 2.0mg or less, you can consider yourself fortunate. These are dosages that are low enough to avoid many of the unwanted effects that you are concerned with.
- Scott
Posted by jjj on May 18, 2005, at 10:21:21
In reply to Re: risperdal withdrawl causing more symptoms, posted by JACJ on May 18, 2005, at 6:38:15
Hey JacJ,
I've been taking risperdal at various doses for close to two years. My first psychotics symptoms started sometime during the summer of 2003.
My doctor is aware of my desire to see how I'll do on lower doses and is supportive of that. He's helped me by providing timeframes for each step down in the dosage. Also, I'm taking a sleep aid to help with the sleep loss due to the withdrawl symptoms. He also has suggested starting up on seroquel while lowering the risperdal because apparently it is an easier withdrawl. That is another option, but I haven't tried it yet.
I'm sorry to hear about your problems with anxiety that appear to be caused by your medication. I can imagine that it must be terribly frustrating to have a medicine that is supposed to help you, cause problems for your instead.
I'm not sure how long the extra psychosis due to withdrawl should last. My pdoc recommends stays at the same dosage for two weeks before lowering a little bit, so I assume it will be something along those lines.
jjj
Posted by jjj on May 18, 2005, at 10:40:35
In reply to Re: risperdal withdrawl causing more symptoms » jjj, posted by SLS on May 18, 2005, at 8:28:58
Hey SLS,
hmmm. I'm not sure what I'm diagnosed with. I guess it could be considered psychotic depression, although I don't feel especially depressed anymore, yet the psychosis is still happening. I've had one hypomanic episode in the past, but I believe it was induced by medication. It only happened once and hasn't happened again. Not sure if that rules out bipolar, but if I am bipolar, it is a very slight case. I don't experience drastic changes in mood. My pdoc has concentrated on treating my symptoms and hasn't provided a definitive "diagnosis".
I'm extremely self critical, although with treatment I've been learning to accept my faults and generally let things go instead of mulling over them and making myself upset about something I didn't do, or something I don't like about myself.
I have hallucinations, generally when going to sleep or waking up, that my neighbor in the next room is screaming, muttering, generally talking bad about me. He apparently is tracking all my movements (apartment has pretty thin walls), and is upset about how I spend my time. The voices are extremely critical of me and my decisions.
I have not experienced other hallucinations. They have been pretty contained and only happen in my apartment. When they were really severe, I'd hear the neighbor all the time, but it still was this one voice. Because of how limited these hallucinations are, I've grown accustomed to them. When it happens I can say to myself, "this isn't really happening". I think if the experiences were more diverse, it would be much more difficult.
When this all started I was totally convinced that my neighbor was really pissed at me. It took me a long time to discount the experience. I listened against the wall with a glass, ran a tape recorder, invited a friend over to listen, etc... Even after confirmation, it was hard to determine the validity of the experience. It is very life-like.
I've recently started trying a sleep aid, to help avoid the hallucinations. Seems to work pretty well. I still have some when I'm laying down to get to sleep, but the sleep medicine keeps that time period pretty short. I slept through the night and didn't have any problems where the hallucinations would wake me up at 4:00am like what would usually happen. (last night was the first try at this, so hopefully things will go well.)
Thanks for the additional information about the backlash symptoms. It is good to hear confirmation about that aspect of risperdal withdrawl. I will stick things out and see what happens.
jjj
Posted by SLS on May 18, 2005, at 11:35:56
In reply to Re: risperdal withdrawl causing more symptoms » SLS, posted by jjj on May 18, 2005, at 10:40:35
Hi.
I admire your determination to improve yourself. I wish you luck on your quest.
It sounds like you have schizoaffective disorder rather than a psychotic depression.
Seroquel turned out to be a better drug than was initially thought. It really can promote a stabilization of psychosis, but the dosages need to be higher than what is effective as a sleep aid. I think one would need 300-600mg to obtain the desired antipsychotic effect. Even at these therapeutic dosages, Seroquel carries a reduced risk of those things that concern you as long-term side effects.
- Scott
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