For some reason they prescribe anti-psychotics for Anxiety disorders. I don't understand why though since they decrease serotonin and the lower serotonin levels can make panic attacks/anxiety worse.

Because at lower-than-psychotic-treatment doses, major tranquilizers become effective for anxiety. They also work for people who experience sensory overload. As an Asperger surely you are familiar with sensory overload? ;)

Yes I am, and I think the 0.5mg risperdal is helping a bit. I wonder if they make an equivilant Invega dose for that? I would think Invega being newer could cause fewer side effects... (best guess).

I now take risperdal twice a day (0.125 mg in the AM and 0.25 mg in the PM). I was taking it as a rescue med for my hypersensitivity, but the wellbutrin I am on has been exacerbating my anxiety and causing me to have problems with ocd.

In any event my doc okayed me to take risperdal twice a day and reduce my wellbutrin. As a result, my anxiety has improved a lot.

ME :D

Ofcourse severe anxiety can require anti-psychotics. (They also can be used as anxiolytics, BTW.)

Take-downs for "Code White" (VIOLENT PATIENT code) on Psych Wards (at least around here) are done with a shot of Haldol and Ativan.

-->Often anxiety is a component of any agitation which progresses to a Code White, from what I have learned. (As is Alexithymia. Such people might only know how to 'talk with their disruptiveness or their fists', etc.)

-----------------------------------

Both anxiety and depression (often anxiety's bedfellow) can be so severe OR progress to such a level -- where, yes, they become (or look something like the impaired thinking/functioning in) psychosis.

eg--> Think severe PTSD (reliving the extreme anxiety warranted from a past scenario is being triggered/re-activated currently, in lesser deserving scenarios).
--> or severe depression (postpartum depression which escalates to postpartum psychosis; women who kill their babies think things like that they are 'saving them from the Devil', a psychotic delusion).
-->some people with depression can feel "guilt" for things that are not their fault; or they believe that "everyone hates them" -- both being unwarranted beliefs.


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It is possible for reality testing to be very much impaired, or the appearance of delusions (fixed false beliefs despite proof of reality) to occur, in severe mood or severe anxiety disorders.

Another form of temporary psychosis is 'Delirium', or "acute confusional state" which can be triggered by many causes (after infection, fever, blood loss, head injury, toxic drug levels, anesthesia, severe bodily injury, a severe psychological trauma, etc) is also a form of psychosis, albeit temporary. It can be hyperactive (anxious, agitated, or aggressive) or hypoactive (sleepy; dozy).

I have had delirium myself on a number of occassions. eg hemorrhage; very high fever; meds reaction post-op; mono infection (infections mess with the brain in a big bad way).
NB Delirium is a medical/psychiatric emergency. (Many RNs, etc do not know this.)

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People with depression and anxiety disorders (eg PTSD) and dissociative disorders (eg DID) can even hallucinate, or have a 'brief psychotic episodes'.

Psychosis is not always permanent, either. It is more common than you think. (I have a family member whose depression has escalated to psychosis in the past. The main thing is to keep stressful situations and stressful people/relatives away from them. <G>)

Whatever works to reduce the distress and symptoms (while having a low side effect profile) is what I'd go for.
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NB. People really underestimate the potential seriousness of untreated/undertreated depression.
It has a death rate of 10 percent, or so. Quite high. (Similar to eating disorders; schizophrenia has an even higher death rate, IIRC. Cannot comment on bipolar's mortality rate.)

I thought anti-psychotics potentiated serotonin. They block certain serotonin receptors, but the end result is increased serotonin turnover. Could be wrong.

I'm thinking since it's blocking the recepter's it would be decreasing serotonin...

dexedrine is my sensory savior, I fly into rages over clock ticking and that kind of thing, the issue I ever encounter with antipsychotics even at the slightest doses is that I become excessively restless worse than normal and the worst experience I had with that was the two weeks I spent awake after getting a 25 mg Risperdal Consta shot, everyone is different though so the doc could be the helper.

The only thing is that she is prescribing me these meds for the wrong reasons. She thinks the zoloft 100mg will help with the fidgetting and then she tells me 50mg is too low? I've been on 50mg for 3 years now and there has been no problem for me on 50. Also the risperdal she says will help with the agitation side effect. I haven't seen much of a difference yet, but I've only been on it for 10 days at this point. I will wait till the 1/29 to make a full dicision on it...

50mg of zoloft is low. Most people are titrated up to at least 100mg before it makes a difference in symptoms. I read that doctors often under dose antidepressants, causing the patient not to derive the optimum effect. This happens with stimulant medication too.

As we all say, "everyone reacts differently".

Sounds like their is a disconnect between what you and your doctor are treating. Does your doctor think you have depression?

Since I have a new psychiatrist I think she thinks I have depression. 50mg was working fine for 3 years. No problems other than fidgetting. I tried stimulents but they cause tics so I don't know where to even go from there. Strattera made my agitation/irritablity worse and without a mood stabilizer to back me up I cycle every other month. Increasing the zoloft I know is only gonna make it worse. I want to go back down to 50mg since it is effective for me at that dose. I was told by my previous psychitrist that I'm a "Rapid Cycling Bipolar Aspie". I guess that's a hard pill in it's own right to swallow, but I'm managing day by day. I currently have a risperdal prescription for 0.5mg every evening at bedtime, which I've been taking for approx. 12 days now. I see the doctor soon. I'm gonna tell her to decrease the zoloft dose back to 50mg and go from there once that is finished. That's my plan anyways.

My plan is working. I now have the 50mg zoloft for which I took one this morning. I'm off the lunesta and sleep aids for a month and still on the same risperdal dosage.

I found that the higher dose helped me so I'm taking the 100mg dose again...

My anxiety levels are SO much lower now. Less wellbutrin and more risperdal really did the trick for me. I can't take SSRI's because of the rick for bipolar. Between that and epilepsy I have a limited regime of meds that I can take.

ME :D

Ok. I don't like that I have to take this many meds either but whatever it takes to stay stable...

I now take risperdal twice a day (0.125 mg in the AM and 0.25 mg in the PM). I was taking it as a rescue med for my hypersensitivity, but the wellbutrin I am on has been exacerbating my anxiety and causing me to have problems with ocd.

In any event my doc okayed me to take risperdal twice a day and reduce my wellbutrin. As a result, my anxiety has improved a lot.
Speedo,

How much wellbutrin are you taking? I am still on the 150 mg starter dose and it has increased my anxiety. I take xanax, (.5) generally 1-2 per day depending on the anxiety. Have needed 3 on some days now. Especially to sleep because wellbutrin keeps me awake (unlike zoloft).

My doctor handed some risperdal in 1 mg tablets on what I think was a whim, and I haven't taken any yet. I have heard it can cause weight gain and other side effects. Where are you getting .125 mg tablets?

I would really like to get rid of my anxiety. I have also heard Risperdal is expensive.

Just wondering! And Thanks! :D

Jeaniebug;

1 mg of risperdal is a huge dose for most people. I used to take 0.5 mg tablets once a day. Now I have 0.25 mg tablets instead. I get the 0.125 mg dose by cutting 0.25 mg tablets in half.

Risperdal is VERY expensive, which is why I cut larger dose tablets in half to get a smaller dose.

I am down to cutting 75 mg ir buproprion (generic wellbutrin) tablets in half. I take it once , in the morning, so I don't have sleeping problems. It stil helps my attention at that small a dose, but it is not as good as I wish it was.

I seem to be rather sensitive to medications, so I get to get off a lot cheaper on meds than most people. It's a good thing I guess, but it is sometimes difficult (or impossible) to titrate to the right dose.

My anxiety has improved a lot, so I'm not inclined to change things unless I must.

Me :D


Speedo,

How much wellbutrin are you taking? I am still on the 150 mg starter dose and it has increased my anxiety. I take xanax, (.5) generally 1-2 per day depending on the anxiety. Have needed 3 on some days now. Especially to sleep because wellbutrin keeps me awake (unlike zoloft).

My doctor handed some risperdal in 1 mg tablets on what I think was a whim, and I haven't taken any yet. I have heard it can cause weight gain and other side effects. Where are you getting .125 mg tablets?

I would really like to get rid of my anxiety. I have also heard Risperdal is expensive.

Just wondering! And Thanks! :D

I know it saves you money speedo but I learned from experience, mom, and the doctor that it's not a good idea to be splitting pills in half because you may be getting either too much or too little of the medication due to some poder comming off of 1/2 of the pill and also, we can't make it exactly, completely even...

...I would really like to get rid of my anxiety. I have also heard Risperdal is expensive...

Just wondering! And Thanks! :D
I know that for my 30 pills of .5mg risperdal it would cost me $89+ w/o insurance. the pills are split in 1/2 to get that little a dose as the lowest dose possible is .25mg.

here's post I made on the FDA's approval of risperdal and Asperger's if you are interested jeaniebug:

http://www.addforums.com/forums/showthread.php?t=36799

I think you should start lower than 1mg because it will take time for your body to adjust to the medication and you do have to think in terms of side effects too. You don't want to get major side effects from going on to high a dose or jumping up too quickly. Just may thoughts. Feel free to disagree...

Andy...

Jeaniebug; I am down to cutting 75 mg ir buproprion (generic wellbutrin) tablets in half. I take it once , in the morning, so I don't have sleeping problems. It stil helps my attention at that small a dose, but it is not as good as I wish it was.

My anxiety has improved a lot, so I'm not inclined to change things unless I must.
Thanks for the advice, speedo. I started just taking the wellbutrin in the morning and it made a huge difference the first day. OMG, why didn't I think of that. :faint:

Am going to avoid taking risperdal until (or if) prescribed by my new neuropsychologist.

All in all I really like the energizing aspect of the wellbutrin. The anxiety is better if I only take it in the morning, most of my anxiety happens in the evening so better in every way. Thanks again. ;)

Good Luck Jeaniebug...

Good News: Risperdal .5mg helps my anxiety

Bad News: Currently none...

Netsavy, are you able to exercise any. There is good research that exercise also helps relieve anxiety.

Take care,
Scattered

I make sure to excersize regularly. I'm working on increasing the amount of excersize I do.

hey everyone, I have been taking the INVEGA version of Risperdal (3mg). I've been having a rapid heartbeat along restlessness. Anyone out there have any input (I was on ABILIFY 3mg but just couln't take it. I got extreme restlessness and (at 1mg) EPS symptoms. I was told to stop after 3 weeks. I have most of the same side-efffects with INVEGA except I'm out of breath after the most simply tasks (going up and down stairs and just standing up or standing around gives me a rapid heartrate and restlessness). I have had a decent mood lift with both AP's but they don't outway the RLS and inner-restlessness feelings. Sorry, point being, I have been 'dx' with ADD and have been given trials of these AP's? I also have anxiety issues but have never ever felt Bi-Polor at any time of my life? Thanks for any input.

APs are possibly going to worsen add symptoms because of the way APs work. In order to help the ADD you have to either take a stimulant, strattera, or clonidine, as those are approved for ADD. Invega, Risperdal, and Abilify can be used off-label for the anxiety and are considered better because of a lower liklyhood of abuse when compaired to older benzodiazipines (valium, xanax, atavan). It sounds like the abilify was working better for you. Unfortunatly the restlessness would return. It is a very common side effect with abilify. I don't like what I am reading about you getting out of breath very often. I think that's something even your physican should know about. It doesn't sound too good. The best thing I think you should do is speak with the doctor about what problems you may be having and see what other treatments could work for you... Best of luck...

Andy...

Risperdal is actually used as and off-label medication for ADHD.
It does help attention.

Jeaniebug: watch out for anxiety/anger with wellbutrin. It may take a few weeks for it to surface (if it does).


Me :D

Wow. I didn't know that speedo. that's why I posted against using it for attention. I know it doesn't help mine. I know everyone is different...

Risperdal is one of those meds that has a wide variety of uses and few side effects (at low doses) for most people. I like it because it helps with sensory issues and reduces my anxiety a lot.

Me :D

helps the sensory issues for me too. But I think it's complicates my anxiety a minor deal...

Hi this is my first post.

There was a trend until recently for doctors (thank you drug companies) to use anti-psychotics for "off-label" uses. They used them for depression, anxiety, sleep disorders, you name it. With anxiety/panic disorders a lot of doctors felt that (and still do unfortunately) that anti-psychotics where better because they weren't addicting like benzodiazepines. Well anti-psychotics can be very dangerous and have severe side effects, infact some serious side effects are common.

Here is some stuff I pulled off of wikipedia:

Antipsychotics are associated with a range of side-effects. It is well recognized that many people (around two thirds in controlled drug trials) discontinue antipsychotics, partly due to adverse effects.

Extrapyramidal reactions include acute dystonias, akathisia, parkinsonism (rigidity and tremor), tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, and hyperprolactinaemia.

The atypical antipsychotics cause weight gain.

Clozapine also has a risk of inducing agranulocytosis, a potentially dangerous reduction in the number of white blood cells in the body.

One of the more serious of these side effects is tardive dyskinesia, in which the sufferer may show repetitive, involuntary, purposeless movements often of the lips, face, legs or torso. It is believed that there is a greater risk of developing tardive dyskinesia with the older, typical antipsychotic drugs, although the newer antipsychotics are now also known to cause this disorder. It is believed by some that the risk of tardive dyskinesia can be reduced by combining the anti-psychotics with diphenhydramine or benztropine, though this has not been established. Central nervous system damage is also associated with irreversible tardive akathisia and/or tardive dysphrenia.

here is my favorite one:

Another serious side effect is neuroleptic malignant syndrome, in which the drugs appear to cause the temperature regulation centers to fail, resulting in a medical emergency as the patient's temperature suddenly increases to dangerous levels.

Risperdal can occasionally cause breast tenderness and eventually lactation in both genders may occur.

The overuse of these drugs makes me so mad. They are anti-PSYCHOTICS, so IMHO they should only be used for psychosis and not other things. If I were a doctor I'd take the risk of abuse with benzos over anti-psychotics anyday.

RE: 15

Wellbutrin has caused anxiety problems for many people I know who have taken it. (In real life.)

Getting off it made the anxiety go away.

atypical antipsychotics are also prescribed for OCD.
I've been on risperdal for about 2 years at a low dose and I have no side effects other than gaining weight easily.

It helps anxiety and it helps me put on the brakes more easily when I'm dealing with ocd. It also helps me tolerate my sensory issues a bit better... probably by reducing anxiety.

I'd rather take risperdal than an SSRI any day. SSRI's have some rather nasty side effects that can be pernanent.

The thing with risperdal is you really need to watch out for side effects. If you have side effects with risperdal you need to talk to your doctor about it right away as some of the side effects can become permanent if you keep taking it. In all fairness most problems with side efects and atypical antipsychotics are associated with higher doses. For people treating ADHD, anxiety, OCD or AS, the doses are a faction of the doses used to treat schizophrenia, psycosis, or bipolar disorder.


ME :D

Yes. For example, with Abilify the normal dosage is 10 to 15 mg for bipolar and I'm on like what, 2...

I should of added that if anti-psychotics work well without serious side effects then there really is no issue. I also forgot to mention it works for bipolar disorders and OCD. (I am not fond of lithium use for bipolar patients). And as you said you are on low doses which should be safe. I just worry about people's health because I am a Pharmacy Technician and I know how shady drug companies can be.

I have never found antidepressants to be calming at all, but it does work for people and is the first line treatment for GAD and anxiety. The next step really should be a benzodiazepine since those are safer, the only time they are dangerous is when they are combined with alcohol or other CNS depressants. But I am glad that you guys aren't having issues and are doing well. I'm just watching out for people. :)

benzodiazepine since those are safer, the only time they are dangerous is when they are combined with alcohol or other CNS depressants
Nonsense. Benzodiazapines are extremely addictive, and the tendency to over-use these drugs is rather common. I am not insinuating that all people will over-use them (I managed to use them on and off for 15 years and never became addicted) but there is some degree of risk beyond possible side effects with these medications. This risk certainly does not make them "safer" than an AP used at extremely low doses.

I am not fond of lithium use for bipolar patients :eyebrow: *coughs*

I am sure that we appreciate this little pearl of wisdom, but speaking as a bipolar with some degree of leeway to speak for my fellow bipolars here at ADDF, I have got to inform you that when you happen to actually BE the bipolar? You are darn glad to find whatever works for you, no matter what it is.

Lithium is no longer a first-choice medication, especially for the less severe forms of bipolar, but it happens to have an excellent track record as a mood stabilizer, side effects notwithstanding. Would you perhaps prefer the use of Depakote, which is also effective for some patients who experience severe manias, yet certainly carries a whopping risk with it, namely liver damage. :rolleyes:

FTR, I scarcely think a pharmacy technician has the right to be fond or not fond of a doctor's choice to RX any medication, and I speak for myself...but I have a sneaky suspicion that the other members of the ADDF Cycling Team might have their own 2C to add....and if not, I reckon they have no issues with my own post.

Yes. For example, with Abilify the normal dosage is 10 to 15 mg for bipolar and I'm on like what, 2...Good point Andy! I was able to manage with only 5mgs per dose myself, since you did ask about my personal use of Abilify. :)

Low serotonin is not the direct cause of anxiety (meaning that low serotonin causes a chain of other changes, such as an increase in catecholamines and hormones). There are other drugs that lower serotonin that can relieve anxiety, such as barbiturates and antihistamines. Serotonin is a "wakeful state" regulatory neurotransmitter (it's mostly inhibitory). Other inhibitory neurotransmitters include GABA, Taurine, and even Dopamine in some contexts. More GABA tends to imply less dopamine, norepinephrine, and serotonin.

GABA is the most important neurotransmitter for sleep. The main role that serotonin plays is in the creation of melatonin, which is like a naturally produced benzo that is released at bed time with respect to circadian (i.e. time each day) and homeostatic (i.e. need for sleep) system input.

I just have to say that for me, risperdal has been a miracle.
It does a good job with helping me to control anxiety and ocd and I'm really grateful to have something that helps. Otherwise I'd be right back in the mess I was a couple of years ago... stuck with ocd rituals, anxiety, and freaking out due to sensory overload, etc.... I don't want to go back to that, I dread the very thought of it.

Me :D

Nonsense. Benzodiazapines are extremely addictive, and the tendency to over-use these drugs is rather common. I am not insinuating that all people will over-use them (I managed to use them on and off for 15 years and never became addicted) but there is some degree of risk beyond possible side effects with these medications. This risk certainly does not make them "safer" than an AP used at extremely low doses.

:eyebrow: *coughs*

I am sure that we appreciate this little pearl of wisdom, but speaking as a bipolar with some degree of leeway to speak for my fellow bipolars here at ADDF, I have got to inform you that when you happen to actually BE the bipolar? You are darn glad to find whatever works for you, no matter what it is.

Lithium is no longer a first-choice medication, especially for the less severe forms of bipolar, but it happens to have an excellent track record as a mood stabilizer, side effects notwithstanding. Would you perhaps prefer the use of Depakote, which is also effective for some patients who experience severe manias, yet certainly carries a whopping risk with it, namely liver damage. :rolleyes:

FTR, I scarcely think a pharmacy technician has the right to be fond or not fond of a doctor's choice to RX any medication, and I speak for myself...but I have a sneaky suspicion that the other members of the ADDF Cycling Team might have their own 2C to add....and if not, I reckon they have no issues with my own post. My opionions shouldn't be taken for medical advice, but just a food for thought. That's all. Doctor's are doctors, they went to medical school for a reason. Just because I am a pharm. tech. doesn't mean I have no experience with the dangers of some medications. Also, my family has an extensive medical background, mom's a critical care registered nurse at the VA Hospital in Detroit and before it was in Detroit, it was in Allen Park, MI. She's been a nurse since 1972. My brother is a pharmacist, and my sister is a psychologist. I know plenty of people who accidently overdosed on lithium and had lithium poisioning, it's very easy to do, and very scary. I also have bipolar friends, and I know the struggles of everyday life for them, so yes I do agree if they find something that works for them, then why change, as long as it doesn't harm them. My best friend is bipolar, btw. I have severe suicidal depression, and have tried everything, tricyclics, TCA's, SSRI's, DRI (welbutrin), and even the MAOI Emsam patch. I found that Cymbalta at 120mg works for me.

Benzodiazepines can be dangerous if taken in large doses due to addiction and abuse, but this can all be monitored by the doctor, and to watch out for withdrawl systems, you taper off. Compared to anti-psychotics they have less dangerous side effects, but as you said in extemely low doeses it shouldn't be an issue, but everyone is different. That is all I am saying. If I offended people, I am sorry. I was just offering my input, which again should not be taken as medical advice.

... Otherwise I'd be right back in the mess I was a couple of years ago... stuck with ocd rituals, anxiety, and freaking out due to sensory overload, etc.... I don't want to go back to that, I dread the very thought of it...I'm regressing to this point myself. I'm getting more anxious now then I was in the past.

I just have to say that for me, risperdal has been a miracle.
It does a good job with helping me to control anxiety and ocd and I'm really grateful to have something that helps. Otherwise I'd be right back in the mess I was a couple of years ago... stuck with ocd rituals, anxiety, and freaking out due to sensory overload, etc.... I don't want to go back to that, I dread the very thought of it.

Me :DHey if you want to read my long post about my panic attacks and anxiety, it's a thread or two under this. I struggle every day since it developed into agoraphobia and I honestly don't know how to defeat that. It really ruins my life. The Xanax has cured my panic attacks but not the agoraphobia. I feel trapped and I am an outgoing loving person. Before I found Cymbalta, I was trying to kill myself and was in a deep depression, I would never switch, it saved my life. I know what you mean.

I use to get panic attacks. I take pexeva (an anti-depressant) and it helps greatly.