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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by floatingbridge on September 12, 2011, at 15:16:16
How long is a fair trial of risperdone to be specific.
I have finished 6 weeks.
Would 8 make a difference? By letting benefits emerge or by being able to say, we gave it a full trial?
Ten weeks?
I suspect, that while it has benefits, a new to me sense of anhedonia is creeping in. Right about during the trial.
So, I am asking because I tend (understatement) to be hasty and reactive with medication. I want to stay steady and need help remaining as level-headed as possible.
Thanks for any input.
Posted by Phillipa on September 12, 2011, at 16:07:09
In reply to How long is a fair trial?, posted by floatingbridge on September 12, 2011, at 15:16:16
Not haven taken an ap I'd think that six weeks would give the med enough time to saturate your body. Is the resperidol no longer working? Thought was helping? Love Phillipa
Posted by herpills on September 12, 2011, at 16:16:58
In reply to How long is a fair trial?, posted by floatingbridge on September 12, 2011, at 15:16:16
I think APs show their potential benefits/side effects quicker than some meds, so I would say 6 weeks is a fair trial... herpills
Posted by floatingbridge on September 12, 2011, at 16:27:31
In reply to Re: How long is a fair trial? » floatingbridge, posted by Phillipa on September 12, 2011, at 16:07:09
> Not haven taken an ap I'd think that six weeks would give the med enough time to saturate your body. Is the resperidol no longer working? Thought was helping? Love Phillipa
Well it helps calm/sedate me at night. I have also read it helps induce (no miracle cure) a deep wave sleep.
But I have realized I now understand what anhedonia is in a new way. So I don't know. Weighing when I can the benefits/sx thing. I'm not sure, so wanted feedback about time in case it's discussed at my next appt.
Thanks for the responses.....
Posted by jono_in_adelaide on September 12, 2011, at 19:43:13
In reply to How long is a fair trial?, posted by floatingbridge on September 12, 2011, at 15:16:16
What dose are you on? For anxiety/depression, you need 0.5 - 1mg per day.
When I started 1mg per day I felt some improvement within 24 hours, and a lot of improvement within 3 days
Posted by Dinah on September 13, 2011, at 1:02:45
In reply to Re: How long is a fair trial? » Phillipa, posted by floatingbridge on September 12, 2011, at 16:27:31
Is it possible that you weren't able to experience anhedonia when you were very agitated? And that the reduction in agitation brings this into focus?
For myself I'll take anhedonia over anxiety/agitation any old day. Not that Risperdal causes that for me. But I do say sometimes that the only energy I have comes from anxiety.
Posted by floatingbridge on September 13, 2011, at 8:18:45
In reply to Re: How long is a fair trial?, posted by Dinah on September 13, 2011, at 1:02:45
> Is it possible that you weren't able to experience anhedonia when you were very agitated? And that the reduction in agitation brings this into focus?
>
> For myself I'll take anhedonia over anxiety/agitation any old day. Not that Risperdal causes that for me. But I do say sometimes that the only energy I have comes from anxiety.I'll have to think about this, Dinah. It's interesting. I think agitation seems preferable to anhedonia because it is more of a feeling, albeit not a productive one.
Have you felt anhedonia and moved through it? I can barely stand it. It frightens me. Because with it comes zero drive for me. I am watching myself seem hopeless and lost.
Posted by Dinah on September 13, 2011, at 8:39:54
In reply to Re: How long is a fair trial? » Dinah, posted by floatingbridge on September 13, 2011, at 8:18:45
Yes. I think so. I'm not sure I passed through it by means of medication.
I think I have gotten that sense from you. That you desire the stimulation of mild hypomania. I could be wrong. I often am. I hate the jangly nerve feeling so much, the feeling that a gentle breeze burns my skin, the constant creepy crawly agitation, that I would put up with a great deal to be rid of it. Do you prefer the feelings that made you want to die, over an inability to feel pleasure? If I'm understanding correctly that Risperdal has helped with the former?
But as my best pdoc said. All medication has side effects. Not taking medication has side effects. It's up to you to choose the side effects you want.
But I do question whether anhedonia is a direct side effect, or an indirect one from the decrease in adrenaline and anxiety. It sounds, from what you say, that Risperdal has been relatively effective in what you started taking it for. Your posts here at Babble sound calmer and more centered. Not in your thinking, which was always logical and centered, but in your tone. They sound less desperate. But it's entirely up to you to decide which side effects you prefer.
What does your husband think? I often find those around me have a better sense of my ability to function than I do.
Posted by floatingbridge on September 13, 2011, at 9:10:38
In reply to Re: How long is a fair trial? » floatingbridge, posted by Dinah on September 13, 2011, at 8:39:54
You are very observant. I am more centered, but it costs something so far. The world seems starker and less colorful.
I actually, silly as it sounds, have an email out to him (my husband) with those questions.. Our hours do not always coincide at the moment.
You have given some very good food for thought. If I can really digest it, I will take it to my doc appt. tomorrow.
So far, risperdone is like an Eeyore pill. But Eeyore was a bit of realist.
I sound less desperate? That is a miracle ;-)
You probably know, but life has real pressures and constraints. I'm not happy about facing them front on.....
Have a good day with those dogs as your co-pilots. Or is it the reverse order?
Posted by Dinah on September 13, 2011, at 12:22:36
In reply to Re: How long is a fair trial? » Dinah, posted by floatingbridge on September 13, 2011, at 9:10:38
If it is at all helpful...
I discussed this with my therapist today, because it touched on something we had discussed recently in therapy. He says that there are those who believe that intensity of feeling and the accompanying brain state can become addictive in a way, so that the brain craves the intensity - even negative intensity - when it is withdrawn. And that if someone can ride out that period of craving, the brain can readjust to the lowered intensity, and the craving and feelings of flatness can decrease. I'm paraphrasing, and I'm not sure how well I'm doing it.
I always assumed that what flatness I felt was a symptom of my underlying depression. Gradually it passed. I think my therapist encourages me to feel, or perhaps to live in the real world instead of in my brain, by playing emotional songs or watching emotional movies that I could not have tolerated without pain when I was overaroused. Even happy songs irritated my nerves at my most agitated.
For what it's worth. :) I thought I'd pass it on.
And yes, you do seem more grounded and less desperate. Although I also have the impression you've been around here less. I had hoped it was because you were feeling better, but perhaps that's a sign of apathy.
As little as I like headon meeting of problems, in the long run I suffer less distress when I do attempt it.
Posted by Phillipa on September 13, 2011, at 19:37:47
In reply to Re: How long is a fair trial? » floatingbridge, posted by Dinah on September 13, 2011, at 12:22:36
Dinah I understand perfectly what you are saying as I so relate had a pdoc say I didn't know how to accept being treated well as childhood and first marriage had been so traumatic. I've always craved excitment. Probably why I loved working locked unit in psych and nursing in general as never knew what would happen next. I craved the high from running also. FB are you kind of the same? But then you are very centered also? Phillipa
Posted by Dinah on September 13, 2011, at 22:42:24
In reply to Re: How long is a fair trial?, posted by Phillipa on September 13, 2011, at 19:37:47
I *think* my therapist was considering it in terms of brain chemicals. He'd explain it better than I did, I'm sure. But I think on this occasion he wasn't referring to a psychological drive. He certainly does, from time to time. But not this time, I think.
Posted by floatingbridge on September 14, 2011, at 22:55:01
In reply to Re: How long is a fair trial? » floatingbridge, posted by Dinah on September 13, 2011, at 12:22:36
> If it is at all helpful...
All your posts were helpful :-). I've been too down to respond adequately, so first off, thank you. I spoke with my husband and got his perspective. Indeed, more depressed, way less 'joy'
So I took your thoughts (after letting them sit) along with my and my husbands observations today to the pdoc. I was pleasantly surprised, and if I may thank you again, I was able to have a discussion I don't think I would have been able to before.
>
> I discussed this with my therapist today, because it touched on something we had discussed recently in therapy. He says that there are those who believe that intensity of feeling and the accompanying brain state can become addictive in a way, so that the brain craves the intensity - even negative intensity - when it is withdrawn. And that if someone can ride out that
period of craving, the brain can readjust to the lowered intensity, and the craving and feelings of flatness can decrease. I'm paraphrasing, and I'm not sure how well I'm doing it.
>My pdoc said this differently, but very much agreed with this and your former post. The agitation, the accustom feeling of intense feeling has been reduced, and that can be very therapeutic. While it can push me into a low, such as a flattening anhedonia, this has been for some patients a readjustment to a new, more 'normal' range. That my mood will pick up.
He believes that AP use in general for non-psychotic patients needs to be revisited every few months. He does not necessarily see this risperdone therapy as continuous especially in light of my depressive symptoms. He understood your-- anonymous friend :-) --use of risperdone PRN under these circumstances as correct usage. That is, as one who has 'reset'.
> I always assumed that what flatness I felt was a symptom of my underlying depression. Gradually it passed. I think my therapist encourages me to feel, or perhaps to live in the real world instead of in my brain, by playing emotional songs or watching emotional movies that I could not have tolerated without pain when I was overaroused.
> Even happy songs irritated my nerves at my most agitated.
This detail really spoke to me. That is how I am, and I suppose it was this small, personal detail that turned the key in my understanding of what the heck I might be doing.
>
> For what it's worth. :) I thought I'd pass it on.
>
> And yes, you do seem more grounded and less desperate. Although I also have the impression you've been around here less. I had hoped it was because you were feeling better, but
perhaps that's a sign of apathy.
>
> As little as I like headon meeting of problems, in the long run I suffer less distress when I do attempt it.Thanks, Dinah.
So like reading the stocks, Emsam resumes it's all-time high of 9mg while risperdone remains a steady .5mg nightly.
All the talk of topamax and stabilizers and AED's were put to rest (whew) with a modest trial of 300mg gabapentin nightly.
My gosh, I was so dreading this appointment.
Thank you, thank you, thank you.
I'm tired, so I hope the typos are not outrageous and I managed to decently respond.
:-)
Posted by Dinah on September 15, 2011, at 9:30:30
In reply to Re: How long is a fair trial? » Dinah, posted by floatingbridge on September 14, 2011, at 22:55:01
Thank you!
I'm glad that the appointment went well.
Here's hoping for a quick "reset". :)
This is the end of the thread.
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