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Hi, I take 40 mg of Citalopram everyday for years. Things are different than they used to be as far as SSRI effectiveness is concerned. I've been on SSRIs since i was a kid, im a young adult now, and they no longer work like they used to. 

I get obsessive thoughts, worries, not typical ocd rituals, and feel tense all the time, plus my mood dips

I've been taking Risperdal for over a week now at 1 mg. Do you think its reasonable to ask my doctor if I can bump it up to 2 mg?  For antidepressant and anti ocd effects, assuming dopamine blockade can aid some things 

How soon does risperdal work for nood

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8 minutes ago, OCDme said:

Hi, I take 40 mg of Citalopram everyday for years. Things are different than they used to be as far as SSRI effectiveness is concerned. I've been on SSRIs since i was a kid, im a young adult now, and they no longer work like they used to. 

I get obsessive thoughts, worries, not typical ocd rituals, and feel tense all the time, plus my mood dips

I've been taking Risperdal for over a week now at 1 mg. Do you think its reasonable to ask my doctor if I can bump it up to 2 mg?  For antidepressant and anti ocd effects, assuming dopamine blockade can aid some things 

How soon does risperdal work for nood

Do you feel any benefit of the 1 mg? 

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Sometimes mood effects are slower than antipsychotic effects. That said, you should always feel welcome to voice your concerns to your pdoc...it’s their job. 

Curious, why did your pdoc pick risperdal over other antipsychotics with more documented mood effects?

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18 minutes ago, Iceberg said:

Sometimes mood effects are slower than antipsychotic effects. That said, you should always feel welcome to voice your concerns to your pdoc...it’s their job. 

Curious, why did your pdoc pick risperdal over other antipsychotics with more documented mood effects?

I dont know why risperdal tho it does have studies.

Im not sure it might help a lil or mentally i just feel reassured

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I was in no way saying it was the wrong choice it just usually isn’t the first choice for mood... but hey maybe that’s why I’m not a pdoc 

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your symptoms sounds somewhat similar to mine. i took risperidone at 0.25 - 0.75 mg along with 225 mg effexor for a couple years. risperidone was mostly for obsessive/racing thoughts, intrusive thoughts and anxiety. it improved my mood in that it cleared my head and allowed me to concentrate, which in turn helped me feel better. i did find it subtle, and often found myself wondering if taking such a small dose had any effect at all. it definitely gave me a "suit of armour", if you will, as i found that when i had to go off of it (started lactating) i felt very exposed, anxious and scared. it helped things roll off my back. without it, everything stung and i ruminated on things anxiously.

i liked risperidone a lot and still take .25 mg PRN when my head gets busy. now i'm on clomipramine, which has been good for me for obsessive stuff and mood. 

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9 hours ago, OCDme said:

Hi, I take 40 mg of Citalopram everyday for years. Things are different than they used to be as far as SSRI effectiveness is concerned. I've been on SSRIs since i was a kid, im a young adult now, and they no longer work like they used to. 

I get obsessive thoughts, worries, not typical ocd rituals, and feel tense all the time, plus my mood dips

I've been taking Risperdal for over a week now at 1 mg. Do you think its reasonable to ask my doctor if I can bump it up to 2 mg?  For antidepressant and anti ocd effects, assuming dopamine blockade can aid some things 

How soon does risperdal work for nood

I've read that risperdal can be good for treatment resistant ocd. As far as mood goes, are we talking bipolar or just mood disorder NOS? In the case of bipolar, risperdal can be effective. It helped me but then I developed some bad side effects and had to quit. I often think about trying it again. From what I've read, low dosage of risperdal can be effective for depression and ocd whereas higher dosage is for bipolar and Schizophrenia.

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9 hours ago, CeremonyNewOrder said:

I've read that risperdal can be good for treatment resistant ocd. As far as mood goes, are we talking bipolar or just mood disorder NOS? In the case of bipolar, risperdal can be effective. It helped me but then I developed some bad side effects and had to quit. I often think about trying it again. From what I've read, low dosage of risperdal can be effective for depression and ocd whereas higher dosage is for bipolar and Schizophrenia.

It isn't for bipolar. It is merely to augment citalopram. Quite Frankly, I also worry if my decades of SSRI use has caused a permanent tolerance to their effectiveness. I dont even experience ssri sexual problems which i gather is rare. 

Is it really fine to be on antidepressants for decades? I guess my main hope is for risperidone to augment it to clear my mind

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16 hours ago, OCDme said:

Is it really fine to be on antidepressants for decades? I guess my main hope is for risperidone to augment it to clear my mind

If illnesses exist for decades they should be treated with what works. I've been on meds for 3 decades, always including an AD. I was on Welburtrin for a decade before it did not work as well so we first raised it to 450 mg then added Abilify. You may find you need to step up dosage over the years or hop to another med with the same indications. Many illnesses progress over time so meds need to also.

Edited by notloki
typos

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On 9/10/2020 at 1:26 PM, OCDme said:

I've been taking Risperdal for over a week now at 1 mg. Do you think its reasonable to ask my doctor if I can bump it up to 2 mg?  For antidepressant and anti ocd effects, assuming dopamine blockade can aid some things 

How soon does risperdal work for nood

Risperidone should reach steady state in the blood stream around 4.5 days after daily administration. But there are changes in receptor sensitivity and expression that can occur for the 2-4 weeks beyond that steady state being reached.

On 9/10/2020 at 1:40 PM, Iceberg said:

Sometimes mood effects are slower than antipsychotic effects. That said, you should always feel welcome to voice your concerns to your pdoc...it’s their job. 

Curious, why did your pdoc pick risperdal over other antipsychotics with more documented mood effects?

 

On 9/10/2020 at 11:28 PM, CeremonyNewOrder said:

I've read that risperdal can be good for treatment resistant ocd. As far as mood goes, are we talking bipolar or just mood disorder NOS? In the case of bipolar, risperdal can be effective. It helped me but then I developed some bad side effects and had to quit. I often think about trying it again. From what I've read, low dosage of risperdal can be effective for depression and ocd whereas higher dosage is for bipolar and Schizophrenia.

@Iceberg @CeremonyNewOrder My pdoc thinks of this like a game of chess. What's the next move? In the case of the OP @OCDme, the pdoc has noticed that citalopram 40mg isn't working the way it used to, so you either switch or augment. However, the patient also reports issues with rumination and obsessive thoughts. Those issues likely wouldn't be addressed with a switch to a different AD (like going from citalopram 40mg to escitalopram 20mg or fluoxetine 40mg). However, you could address both rumination and antidepressant poop-out with an augmenting agent like an atypical antipsychotic. Of course when thinking about augmenting an AD it's natural to gravitate towards aripiprazole. However, the patient reports having issues settling their thoughts, and aripiprazole is liable to push them in the opposite direction. Risperidone and quetiapine (Risperdal and Seroquel, respectively) are the only two atypical antipsychotics that are "silent" dopamine antagonists and can settle the thoughts enough to address obsessive rumination. They both seem to have the most evidence in treating OCD when high dose serotonin reuptake inhibitors aren't an option (like clomipramine 120mg or fluoxetine 80mg)

On 9/12/2020 at 1:39 AM, notloki said:

If illnesses exist for decades they should be treated with what works. I've been on meds for 3 decades, always including an AD. I was on Welburtrin for a decade before it did not work as well so we first raised it to 450 mg then added Abilify. You may find you need to step up dosage over the years or hop to another med with the same indications. Many illnesses progress over time so meds need to also.

+1 It is normal for the brain to adjust over time, even to the medications that we feed it. Think about it this way. When you work out to build muscle mass, you oftentimes need to rotate between different kinds of exercises of a specific muscle group in order to get continuous results or your muscle growth will plateau. This is because the muscles adjust over time to being worked out in a certain way. The brain isn't so different.

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@browri I understand how risperdal can be useful, I was asking about the OPs pdoc specifically because I was wondering if the pdoc felt that certain symptoms were more of a priority (or more severe) than others... which is important when thinking about a med approach

@OCDme did your pdoc talk with u about other types of antidepressants ?

- sorry if I missed that

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14 hours ago, Iceberg said:

@browri I understand how risperdal can be useful, I was asking about the OPs pdoc specifically because I was wondering if the pdoc felt that certain symptoms were more of a priority (or more severe) than others... which is important when thinking about a med approach

Agreed. If certain symptoms are manageable for the time-being, address the more severe ones first. There's always the option of changing the citalopram later too, but you start by adding the risperidone because, generally speaking, OCD symptoms can be distressing and further exacerbate existing depression.

Unfortunately, our pdocs only see us for so long each visit though, and they can try to make a clinical judgement call based on what they see right in front of them, but they do still rely on us to tell them what distresses us most. In my mind, it makes more sense to augment first just because it has a higher chance of success at resolving all reported issues instead of an AD switch strategy which may only resolve one issue.

14 hours ago, Iceberg said:

@OCDme did your pdoc talk with u about other types of antidepressants ?

- sorry if I missed that

This of course is an option as well. If you're on 40mg citalopram, it wouldn't hurt to talk to your doctor about at least trying escitalopram 10mg to see if there's any difference. There may not be, but citalopram is a racemic mixture where the R- enantiomer isn't completely silent. It actually antagonizes some of the effects of the S- enantiomer. So where escitalopram could be more effective, ar-citalopram, makes it less effective. Some people report improvements converting from citalopram to escitalopram. And there's room for dose increases too. Some say that citalopram is half as potent, but with the added antagonist effect of the R-enantiomer, 40mg citalopram doesn't necessarily equal 20mg escitalopram. Citalopram is probably more like a third as potent where 20mg, 40mg, and 60mg citalopram translate more to 5mg, 10mg, 20mg escitalopram, respectively. Except they don't prescribe citalopram up to 60mg anymore due to prolonged QT interval which is apparently less pronounced with escitalopram?

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i just recently hiked my risperdal up to 3 mg a day

my understanding is that this is probably the max to augment ssri as 4-6 is usually used for psychosis.

Not quite sure of pharmalogical rationale but risperdal does block alpha 2 adrenergic receptors in theory increasing serotonin and norepinephrine neurotransmission

Maybe the d2 blockade will help ocd and will not induce anhedonia?

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