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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 iforgotmypassword on May 28, 2005, at 15:44:30
my doctors suggested for me to take an atypical antipsychotic and they have suggested on more than one occassion, does anyone think that these actually help fight depression/fogginess/amotivation anyways? if they do, i really need for them not to have the horrible weakness and fatigue side effects i keep having every time i try to start them. is there any way to avoid these side effects? i am favouring risperdal, (it is the least sedating right? what dose would be best?
Posted by med_empowered on May 28, 2005, at 18:51:24
In reply to risperdal, atypical APs without the fatigue sleep, posted by iforgotmypassword on May 28, 2005, at 15:44:30
hey! Using antipsychotics (old one and the new ones) for treatment of depression is a pretty old "off-label" practice...its becoming more popular now b/c the newer antipsychotics cause fewer problems than the old ones. As to whether it will help you or not...maybe. Maybe not. It could go either way, really. Personally I'd pick Abilify over Risperdal, since Abilify doesn't raise prolactin, has minimal EPS, and usually is non-drowsy. Its also pretty much weight neutral. Geodon is pretty good, too, but has the heart weirdness ("prolongation of the qTC interval") that may cause a sudden death now and then...plus, it limits the meds you can add on to it. Anyway, adding an antipsychotic (usually, it seems that they're added at very low doses, up to maybe the low end of what's used for bipolar/schizophrenia) could help. Then again...if you have motivation/engergy problems, it might be worthwhile to give a stimulant a whirl. Ritalin and Adderall are classic anti-deperssant add-ons; another option would be provigil. Good luck!
Posted by iforgotmypassword on May 28, 2005, at 18:59:44
In reply to Re: risperdal, atypical APs without the fatigue sl, posted by med_empowered on May 28, 2005, at 18:51:24
thank you for your suggestions. unfortunately, i live in canada so neither geodon or abilify are available. ive tried adding ritalin and i go crazy, and i've been going violently crazy off and on in my apartment lately. its ridiculous, i can barely pick myself up to stand so much of the time then i can't keep myself from destroying my apartment.
Posted by med_empowered on May 28, 2005, at 19:27:19
In reply to hmm... » med_empowered, posted by iforgotmypassword on May 28, 2005, at 18:59:44
hey! Sorry about your situation. I didn't realize Abilify and Geodon weren't around in canada. What *might* work better than doing an antypical antipsychotic long-term would be using one short-term and placing in a mood-stabilizer; even if you're not bipolar, mood-stabilizers can help treat resistant depression and help you control anger/aggression without the same level of sedation you'd get from an antipsychotic. Personally, I'm a trileptal and lamictal fan, but depakote is good too, especially when you need some *soothing* effects. Another option might be Symbyax (the prozac-zyprexa combo), although I think you might be better off picking your own antidepressant and dose, and then adding zyprexa. In terms of side effects, zyprexa tends to be kinda sedating and can cause weight gain/diabetes, but doesn't have the same kind of EPS and prolactin crap that's associated with risperdal. If you wanted to get really creative, there's amoxapine (sold as Asendin in the US). Its an old tricyclic antidepressant that's chemically related to loxapine, an antipsychotic. It works on psychotic depression, treatment resistant depression, and may be effective in psychosis. In the begining, its secating, but over the long term it seems to do really well at treating hardcore depression with a pretty good side-effect profile (minimal EPS). Loxapine itself (sold as Loxitane in the US, I think) is an option as an add-on antipsychotic; although its an old drug, it seems to have an "atypical" profile in terms of mechanism of action and side-effects. My only concern with using an antipsychotic in your situation would be that if the dosing isn't done right you could end up with all the side-effects of an anti-psychotic without the benefits..the ideal is to use the antipsychotic in such a way that levels of serotonin, neurepinephrine, and dopamine are actually increased where desired (frontal lobes in particular) while keeping side effects from the anti-depressant and antipsychotic at a minimum (no point in treating the depression if you gain too much weight, sleep all the time, or develop diabetes). Personally, adding BuSpar to my own anti-psychotic/anti-depressant mix helped a lot with the symptoms AND the side-effects. Anyway, sorry this was soooo long, and GOOD LUCK!
Posted by Phillipa on May 28, 2005, at 19:41:36
In reply to Re: hmm..., posted by med_empowered on May 28, 2005, at 19:27:19
Posted by BIGDaddyachmed69 on May 29, 2005, at 8:32:46
In reply to risperdal, atypical APs without the fatigue sleep, posted by iforgotmypassword on May 28, 2005, at 15:44:30
> my doctors suggested for me to take an atypical antipsychotic and they have suggested on more than one occassion, does anyone think that these actually help fight depression/fogginess/amotivation anyways? if they do, i really need for them not to have the horrible weakness and fatigue side effects i keep having every time i try to start them. is there any way to avoid these side effects? i am favouring risperdal, (it is the least sedating right? what dose would be best?
Are you on an antidepressant? I was on Prozac, and we added Risperdal which actually made me more depressed, foggy and amotivated. If it didn't help with the Prozac, I'd hate to try it alone. Actually they went and put me on it again at some point, in addition to Depakote and Strattera this time...my reaction was even worse.
Posted by blueberry on May 29, 2005, at 18:37:57
In reply to risperdal, atypical APs without the fatigue sleep, posted by iforgotmypassword on May 28, 2005, at 15:44:30
Just an opinion, but I would try zyprexa first.
This is the end of the thread.
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