Risperidone....am I too impatient?

[Catwoman]

So today is my seventh day on 0.50 mg risperidone. 
I wanted to try this kind of medication for a long time.  I've been on ssri's for about 10 years and switched to clomipramine July 2018 because ssri's didn't work like they did before. 
(My main problem....I have 'white polar bear' ocd and was free of symptoms for about 6 years. 3 years ago big relapse). I'm on 100 mg of clomipramine.... I tried increasing but then the side effects become too much for me.

I don't think risperidone is doing anything special. I expected a little more, but maybe I'm just impatient.

I was hoping the constant intrusive thought (which has overtaken normal thinking patterns) would become less frequent. 
I hoped silence would come.
Or that it would flatten the emotion that always follows after thinking 'it'.  Like: "I don't care that you (intrusive thought) are on my mind" and that my attention would quickly shift to something else.

On the plus side....I'm sleeping even better than before. It is nice to be able to sleep the whole night instead of getting out (sometimes thrice a night) because I have to pee(which is a side effect of clomipramine).

May I expect better results after two weeks? Of should I ask for a higher dose of risperidone?

Edited March 27, 2019 by Catwoman

[CrazyRedhead]

26 minutes ago, Catwoman said:

So today is my seventh day on 0.50 mg risperidone. 
 

May I expect better results after two weeks? Of should I ask for a higher dose of risperidone?

I replied on your blog, but I will post again here......If you've only been taking it for a week, IMO, I think you need to give it a little more time.........Some folks can see improvement within 2-3 weeks, but it can take up to 4-6 weeks for others to see full effect.

If there's no improvement in 4-6 weeks, you might need a slight increase in dosage, but that would be up to your doc to decide.

[Iceberg]

59 minutes ago, CrazyRedhead said:

I replied on your blog, but I will post again here......If you've only been taking it for a week, IMO, I think you need to give it a little more time.........Some folks can see improvement within 2-3 weeks, but it can take up to 4-6 weeks for others to see full effect.

If there's no improvement in 4-6 weeks, you might need a slight increase in dosage, but that would be up to your doc to decide.

I agree- it’s best to go low and slow with aps especially if its in a non super acute setting (by this I don’t mean that your symptoms aren’t serious but that your not inpatient or totally out of control and need to chill out right the hell now). Otherwise you risk overshooting your optimal dose and getting unnecessary side effects 

[echolocation]

echoing the others and saying you should give it at least another couple weeks. i think i was one of the people who saw effect within a couple weeks, but honestly, i don't remember. i just remember it being fairly fast.

it's good to hear that you're sleeping better. be patient with the risperidone -- seven days is still pretty early in the game. i hope it starts working for you soon. and, of course, you still have a little room to go up. 0.75 seems to be my best dose, but if i'm really agitated i'll take an extra 0.25 sometimes (as encouraged by my pdoc).

[Catwoman]

Thanks you guys!

I thought this kind of medication was supposed to work within 7 days but my pdoc probably meant high dosages in acute cases...

My pdoc is no expert in treating ocd so maybe she doesn't know what to expect from augmenting an antidepressant with an AAP

[HydroCat]

Some time ago I was given .5mg Risperidone to augment SSRIs, specifically for intrusive thoughts. During that time doses changed between .5 and 1mg, depending on the situation I was in.

1mg gives that “quiet” feeling, but may also be a bit flattening.

I had to stop Risperidone at some point, but I really did like it.

Give it some time, if it does nothing then maybe you need a slightly higher dose. .5mg is low anyhow.

[Iceberg]

4 hours ago, Catwoman said:

Thanks you guys!

I thought this kind of medication was supposed to work within 7 days but my pdoc probably meant high dosages in acute cases...

My pdoc is no expert in treating ocd so maybe she doesn't know what to expect from augmenting an antidepressant with an AAP

Yeah I think you’re right, I would think the seven days is more the psychosis/mania time 

[Catwoman]

10 hours ago, HydroCat said:

Some time ago I was given .5mg Risperidone to augment SSRIs, specifically for intrusive thoughts. During that time doses changed between .5 and 1mg, depending on the situation I was in.

1mg gives that “quiet” feeling, but may also be a bit flattening.

I had to stop Risperidone at some point, but I really did like it.

Give it some time, if it does nothing then maybe you need a slightly higher dose. .5mg is low anyhow.

I would love that quiet feeling. Since I started risperidone 8 days ago I've only been obsessing (and ruminating) more. I don't know if this is caused by the new med (like ssri's can make anxiety worse in the first weeks) or if it's "just me" because I'm so worried it won't work.

There's this little voice in my mind saying that anti-psychotics don't work for my type of intrusive thought.☹️



 

[jt07]

Perhaps you need to increase the dose? 0.5 mg is a really small dose. I took risperidone up to 4 mg.

[Catwoman]

22 minutes ago, jt07 said:

Perhaps you need to increase the dose? 0.5 mg is a really small dose. I took risperidone up to 4 mg.

For OCD? Or for anxiety and depression?

I think somewhere between 0.50 and 2 mg is common when used to augment antidepressants, so I have some room.

My intrusive thought is almost constantly there, interrupting my normal thinking pattern. Very worried as well, that it won't work.
I was hoping that risperidone would put a stop to it.

[Catwoman]

Short update....I'm in the third week of 0.5 mg risperidone.
I wake up almost every night (to go to the toilet) with a heavy head and feeling incredibly drowsy.  It's not too bad although I have trouble with getting up.

Does it help with the intrusive thought which bothers me so much?
I felt some improvement this weekend, but I felt this countless times before (while being on an AAP or antidepressant and even while not taking meds). And always, after doing well for a few days or weeks, the intrusive thought returns. And because of my resistence towards the intrusive thought, it is able to remain active. 
So if I could find a way to stop feeling negative about this thought, then the thought wouldn't have so much power anymore.

But that's more the "therapy side" of things.

So aside from sleeping better I don't feel like I'm "on something". 

A trial of 6 weeks seems fair, but on which dose? When do you decide to increase or switch to another AAP?



 

Edited April 10, 2019 by Catwoman

[CrazyRedhead]

2 hours ago, Catwoman said:

A trial of 6 weeks seems fair, but on which dose? When do you decide to increase or switch to another AAP?

I'm not a doc, but if I were you I would give it at least one more week (4 weeks).

If there's still no improvement after 4 weeks, talk to pdoc and let him/her know you're still having the intrusive thoughts........Pdoc might decide then to increase the dose a bit (maybe to .75mg or possibly even 1mg)

I only say wait 4 weeks, because pdoc is probably more likely to consider that a fair enough trial of your current dose.

Edited April 10, 2019 by CrazyRedhead

[Catwoman]

7 minutes ago, CrazyRedhead said:

I'm not a doc, but if I were you I would give it at least one more week (4 weeks).

If there's still no improvement after 4 weeks, talk to pdoc and let him/her know you're still having the intrusive thoughts........Pdoc might decide then to increase the dose a bit (maybe to .75mg or possibly even 1mg)

I only say wait 4 weeks, because pdoc is probably more likely to consider that a fair enough trial of your current dose.

I have a new appointment in two weeks so that would be good.

[CrazyRedhead]

1 minute ago, Catwoman said:

I have a new appointment in two weeks so that would be good.

Yes, I agree, that would be a good time to bring this up......

[Catwoman]

I wonder what a higher dose  of risperidone feels like. Could  it quiet the mind entirely? 

Thinking of stopping clomipramine....I do feel improvement sometimes, but it's not permanent, not even for a few weeks or months. It's more like days....and then I relapse again (having more and more of the same intrusive thought).

Maybe risperidone works better as an adjunct to ssri's than tca's? 
I don't think so because clomipramine is a reuptake inhibitor, just like ssri's....or could it depend on the combination as well?

[CrazyRedhead]

11 minutes ago, Catwoman said:

Thinking of stopping clomipramine....I do feel improvement sometimes, but it's not permanent, not even for a few weeks or months. It's more like days....and then I relapse again (having more and more of the same intrusive thought).

As a general rule, when it comes to psych meds, I think only one thing at a time should be changed, unless it's an emergency type situation where you're hospitalized, etc.

IMO, give the risperdone more time, and possibly a higher dose, before you change anything else.....Of course your pdoc's input would be needed on this as well.

Edited April 11, 2019 by CrazyRedhead

[Catwoman]

7 minutes ago, CrazyRedhead said:

As a general rule, when it comes to psych meds, I think only one thing at a time should be changed, unless it's an emergency type situation where you're hospitalized, etc.

IMO, give the risperdone more time, and possibly a higher dose, before you change anything else.....Of course your pdoc's input would be needed on this as well.

I think I have to agree....the first step would be to increase the risperidone. 

It's just that I'm so fed up with medications which don't 'do' much for me. I'm starting to hate clomipramine....

[CrazyRedhead]

I understand about the feeling of frustration, having tried so many meds myself, without much success.....

The way I feel about my current meds now:.....They are not really improving my anxiety, OCD, or depression, but at least I can sleep ok........If I quit them, I'm scared I would sink even lower.

[echolocation]

i hate that feeling that your meds aren't really doing anything. if i were you, i think i'd get the risperidone to 0.75 or maybe 1 mg for at least a couple weeks, and then try something different AD-wise. do you have any side effects from anafranil, or is it just not working? if it's getting intolerable, maybe your priority is switching ADs.

[Catwoman]

24 minutes ago, echolocation said:

i hate that feeling that your meds aren't really doing anything. if i were you, i think i'd get the risperidone to 0.75 or maybe 1 mg for at least a couple weeks, and then try something different AD-wise. do you have any side effects from anafranil, or is it just not working? if it's getting intolerable, maybe your priority is switching ADs.

I was on Luvox/fluvoxamine last year, but I was really looking for lasting results, so eventually we decided to try clomipramine. The first two, three months (if I recall correctly) I didn't improve much. But last December I had a really nice couple of weeks so I thought that Anafranil was finally doing something notable.

It didn't last that long though, by the end of February I fell back....I did try to increase to 125 mg, but side effects really bothered me. Dry mouth, tremor, (hands) very annoying twitchy muscles (legs, hands, shoulders), constipation....

My next app with pdoc is in two weeks, so I'll ask her about switching to another AD, but I would like to increase risperidone first.

[Catwoman]

Pdoc agreed with going off clomipramine, but for now I'm staying on 100 mg, since we're slowly increasing the risperidone. I'm taking 0.75 mg for about a week now. I'm supposed to go up to 1 mg in a few weeks, which shouldn't be much of a problem. No side effects except for waking up groggy in the middle of the night (because I need to go to the toilet).
I've also put on a few kilo's in the last few months and I notice risperidone is making me crave food more....I can eat all day!

I'm somewhat positive about this med, although I'm not sure if it's working all the time. Maybe this sounds weird. 

In the four, five days before I'm starting my menstrual period I always have more intrusive thoughts (though it's always the same one).
I get strong feelings of desperation and hopelessness; I guess this is coming from hormonal changes, so it's not something I worry about although it's not funny either 🙂

When my period has ended after 6, 7 days I gradually begin to feel better. The intrusive thought slowly decreases. It never goes away for longer periods, but on my best days it doesn't bother me for more than 10 times a day. 

I'm not sure what to expect from risperidone, because it's not making my head more clear nor does it take away the intrusive thought.
I do think I feel an antidepressant action.






 

[browri]

1mg of risperidone is probably a good dose to strive for. Although too far over that may be a bit flattening. My partner has been taking 1mg of risperidone with 10mg escitalopram now for quite some time and it works well for him, he says.

[Catwoman]

On 5/6/2019 at 10:50 PM, browri said:

1mg of risperidone is probably a good dose to strive for. Although too far over that may be a bit flattening. My partner has been taking 1mg of risperidone with 10mg escitalopram now for quite some time and it works well for him, he says.

I've been on 1 mg for some time now and I'm not sure if it works better than 0.75 mg because I keep relapsing. I can have incredibly good days with almost no 'white bear problems' at all (when on vacation for example) and those days can be followed by incredibly disappointing days with continuously the same  unwanted thought on my mind. (this is when I'm back from that vacation for example).

But on the other hand side effects are tolerable. I think I have some hair loss and my libido is low plus I've gained a kilo or 2. 
At some point the low libido (including the slight anorgasmia) is going to bother me too much..... 😞

What does risperidone exactly do at 1 mg? Which receptors does it hit?

[Blahblah]

@Catwoman I often have a similar issue, but with (plural) intrusive negative thought(s). My stimulant helps me to be more focused on 1 single task instead of succumbing to my ruminating/wandering mind...but I've been told there is no medication alone that is going to "control" or wipe out your thoughts. Medicating or trying to sedate yourself into being constantly "empty minded" sounds a bit like chemical lobotomy.

I've been told by pdocs, that meds work in tandem with CBT therapy, mindfulness, etc to direct your attention. I don't know if you have a therapist that is helpful? Someone to help you understand the origin, WHY you are stuck on this 1 thought? Meds work as a partial intervention that can help slow down your thoughts, so that you become more in control (and stop compulsive behaviors & reactions) but I don't think 1 medication will rid your mind of one very specific thought.

Its more about re-training your mind to break the cycle (not easy, I know!!) But I think it's interesting that you mention you can go for long periods without the intrusive thought (vacations, etc) Maybe dive deeper into what's happening there, why you are able to control it in that context?

(btw I don't want to come off as insensitive or offensive, just my humble opinion).

Edited June 28, 2019 by Blahblah

[browri]

4 hours ago, Blahblah said:

@Catwoman I often have a similar issue, but with (plural) intrusive negative thought(s). My stimulant helps me to be more focused on 1 single task instead of succumbing to my ruminating/wandering mind...but I've been told there is no medication alone that is going to "control" or wipe out your thoughts. Medicating or trying to sedate yourself into being constantly "empty minded" sounds a bit like chemical lobotomy.

I've been told by pdocs, that meds work in tandem with CBT therapy, mindfulness, etc to direct your attention. I don't know if you have a therapist that is helpful? Someone to help you understand the origin, WHY you are stuck on this 1 thought? Meds work as a partial intervention that can help slow down your thoughts, so that you become more in control (and stop compulsive behaviors & reactions) but I don't think 1 medication will rid your mind of one very specific thought.

Its more about re-training your mind to break the cycle (not easy, I know!!) But I think it's interesting that you mention you can go for long periods without the intrusive thought (vacations, etc) Maybe dive deeper into what's happening there, why you are able to control it in that context?

(btw I don't want to come off as insensitive or offensive, just my humble opinion).

Yeah in this case, we're talking about a pure "O" form of OCD that so far has not responded well to a variety of different SSRIs and the OP is testing out other options. Risperidone along with quetiapine do have evidence in the treatment of OCD, but I'm not sure how they go about doing it. My guess is that the OCD has something to do with dopamine.

When someone has OCD, you typically give them super high doses of SSRIs or clomipramine for maximal SERT occupancy. This is to suppress dopamine output which for many is the cause of depression, anxiety, and compulsive/impulsive/obsessive issues. So the thinking is that if that isn't enough to suppress dopamine, then add an AAP to further suppress it

However, you are right @Blahblah about the stimulant part. I can definitely second the feeling that a stimulant helps me to focus on the task at hand and ruminate less. However, I believe the OP is in Europe and has a conservative pdoc that may not be willing to take that leap. Not sure. @Catwoman?

As for what risperidone hits at 1mg, Well it's selective for serotonin receptors at doses of like 0.25mg and 0.5mg as well as PRE-synaptic dopamine auto-receptors. So doses below 1mg actually cause dopamine release without blocking any of that increased dopamine signaling on the other end at post-synaptic receptors. Once you get to 1mg you start to occupy a modest amount of post-synaptic dopamine receptors which will start to dampen things a bit. Unless you're treating acute bipolar mania or schizophrenia, there isn't much reason to go higher than 1mg on risperidone. And I say that, but to be honest when you're using it to treat OCD, that could be the totally wrong assessment. It's just that 1-2mg daily seems to be a consensus maintenance dose for risperidone because of its major impacts on prolactin at higher doses.

[Catwoman]

On 6/28/2019 at 5:00 PM, Blahblah said:

@Catwoman I often have a similar issue, but with (plural) intrusive negative thought(s). My stimulant helps me to be more focused on 1 single task instead of succumbing to my ruminating/wandering mind...but I've been told there is no medication alone that is going to "control" or wipe out your thoughts. Medicating or trying to sedate yourself into being constantly "empty minded" sounds a bit like chemical lobotomy.

I've been told by pdocs, that meds work in tandem with CBT therapy, mindfulness, etc to direct your attention. I don't know if you have a therapist that is helpful? Someone to help you understand the origin, WHY you are stuck on this 1 thought? Meds work as a partial intervention that can help slow down your thoughts, so that you become more in control (and stop compulsive behaviors & reactions) but I don't think 1 medication will rid your mind of one very specific thought.

Its more about re-training your mind to break the cycle (not easy, I know!!) But I think it's interesting that you mention you can go for long periods without the intrusive thought (vacations, etc) Maybe dive deeper into what's happening there, why you are able to control it in that context?

(btw I don't want to come off as insensitive or offensive, just my humble opinion).

Hi Blahblah! Thanks for your answer to my post! I've been thinking this weekend about what you wrote and what I wanted to say about it. English is not my native language, so bear with me 😉

I think you're right about the combination of therapy and meds. Although I've never reached total remission with this combination. It were the meds that pulled me out of the circle, which was incredible to me because I had so much (CBT)therapy before starting my first SSRI. It really helped, it was like having more space in my mind, between two thoughts. It was such a good feeling to finally get rid of this one specific thought! So in my experience it was possible.

Unfortunately it didn't last....after six years the unwanted thought returned (and I don't exactly know why), the Lexapro didn't seem to work anymore and I went back into therapy. A new approach this time.
I had talk sessions with a psychologist, I followed a mindfulness based therapy program and after that I had Acceptance & Commitment therapy. Along side I had counselling. I was off meds during that time. 

I also did a lot of research about retraining my brain. I tried various forms of meditation and self hypnosis. I even followed the OCD yoga protocol by David Shannahoff-Khalsa (a kundalini yoga teacher).  Especially mindfulness techniques seemed promising, because you learn to redirect your attention and stay in the present.

The problem is....it's not your typical OCD. What I have is the "white bear problem", in psychology also known as "ironic process theory'.
With trying to suppress a thought it will only make it worse. But how to fully accept a thought that you don't want is about the hardest thing I've ever done.
Just not caring about the thought being in your mind is the key. 

Vacation is the best therapy for me: new environment, no stress, no anxieties, good company, new things to do and to see....And the unwanted thought gradually fades away. 
I think it is because I have so much distraction. The mind is distracted of the unwanted thought. Focus shifts to something else without giving it too much effort.
And when I notice that I didn't have the unwanted thought for a while I feel better.  The longer it gets, the better I feel.

I have to find out where the whole problem comes from, but I suspect it's hidden somewhere deep in my brain and has its roots in my childhood. That's why I also had some Schema Therapy. 
I still have the 'white bear problem'  though....





 

Edited July 1, 2019 by Catwoman

[Catwoman]

On 6/28/2019 at 9:39 PM, browri said:

Yeah in this case, we're talking about a pure "O" form of OCD that so far has not responded well to a variety of different SSRIs and the OP is testing out other options. Risperidone along with quetiapine do have evidence in the treatment of OCD, but I'm not sure how they go about doing it. My guess is that the OCD has something to do with dopamine.

When someone has OCD, you typically give them super high doses of SSRIs or clomipramine for maximal SERT occupancy. This is to suppress dopamine output which for many is the cause of depression, anxiety, and compulsive/impulsive/obsessive issues. So the thinking is that if that isn't enough to suppress dopamine, then add an AAP to further suppress it

However, you are right @Blahblah about the stimulant part. I can definitely second the feeling that a stimulant helps me to focus on the task at hand and ruminate less. However, I believe the OP is in Europe and has a conservative pdoc that may not be willing to take that leap. Not sure. @Catwoman?

As for what risperidone hits at 1mg, Well it's selective for serotonin receptors at doses of like 0.25mg and 0.5mg as well as PRE-synaptic dopamine auto-receptors. So doses below 1mg actually cause dopamine release without blocking any of that increased dopamine signaling on the other end at post-synaptic receptors. Once you get to 1mg you start to occupy a modest amount of post-synaptic dopamine receptors which will start to dampen things a bit. Unless you're treating acute bipolar mania or schizophrenia, there isn't much reason to go higher than 1mg on risperidone. And I say that, but to be honest when you're using it to treat OCD, that could be the totally wrong assessment. It's just that 1-2mg daily seems to be a consensus maintenance dose for risperidone because of its major impacts on prolactin at higher doses.

Yes....my pdoc doesn't think outside the box that much. Although she's giving me some more freedom lately with dosing with both of my meds. 
I'm seeing her tomorrow and will ask her about other options, because 1 mg of risperidone and 100 mg of clomipramine just isn't helping enough.

But maybe medication doesn't help at all with my kind of issue. 

Edited July 1, 2019 by Catwoman

[Catwoman]

Well, pdoc is a little bit more cooperative. I was having a hard time during our talk this wednesday, couldn't stop crying....I'll see her again next week to talk more about switching meds. 

Is there anything to say for switching to aripiprazole or another anti-psychotic?
 
We're also increasing the clomipramine again to see if I can tolerate the side effects this time).