Risperidone problems

Yes i understand that, i do need therapy but told huge wait list.   I am frightened for even going to appointments, how can i get over this do you think?

there is a wait its true, best to be on the list waiting though than not.  Nothing to be scared of seeing a therapist, they are there to help, they arent interested in judging people and will only offer help if you want it, if you dont then they wont force you, its all your call

Yes i desperately need to go and see if theres anything can be done for me.  My anxiety is very high and i am having trouble keeping it under control.  Any anti deps given just make it worse so it needs a new angle.  Hoping dr appt in two weeks will get me on list. Thanks for advice.

psych has offered olanzapine as other augment but its still an anti psychotic and im sceptical it will just do the same.

Thank you.  I have tried lofepramine which is a tricyclic for five months but no change. Then all the others from ssri to snri to gabapentin etc.etc.  I get bad effects from them all, and worst of all they are ineffective for my anxiety/depression.  I have not tried agomelatinwhich gets good reports, or MAO. I am just so fed up with all of this and i now believe there is no med which can help me.  Its a sorry state of affairs feeling this bad for so many months.  My next review with psych I dont know what will come of it. Do you think MAO is a good try?  I did read that it causes permanent damage.  The other things he hasn't tried are lithium or Lamictal, but as im not bipolar these may not be suitable. 

PS forgot to mention i am on warfarin for blood lots so some a/ds are not allowed.  I think one is amitriptylene but not sure.

Ann, MAOi do not cause any permanent damage. These drugs are highly effective and phenelzine (one of the old MAOi) is still the 'golden standard' when it comes to anxiety disorders. The main problem with this group of medications is their ability to raise blood pressure upon consumption of tyramine - a substance present in cheese, beer, wine, yeast extracts and other snacks. This means that while you're on these drugs, you would need to follow a very strict diet knowing that the consumption of certain types of food could trigger a potentially lethal side effect. This is the main reason why many psychiatrists don't feel comfortable with prescribing MAOi when safer alternatives are available. So this is really a patient-doctor trust issue - when it comes to efficiency, MAOi blow SSRI/tricyclics out of the water, there is really no question about that.

?Regarding wafarin, there is no known interaction between wafarin and phenelzine. However, it would be wise to start with a low dose (2 x 15 mg per day) and then increase it if necessary (the typical daily dose is between 60 mg and 90 mg).

Thank you for that great information. I have been down all other routes and now wonder if this might be my last stab at a solution. Maybe they can give you an exhaustive list of items not to eat. I can manage with fresh fish, chicken, pork and veg, with rice cereals for breakfast so avoiding hopefully the dangerous foods.  I would do anything to get better.

do you really think an MAOI is gold standard here? Ive been down so many paths over last four years.  My body just doesnt like meds so far!   The warfarin is a necessity though.

i might ask psych at next appt about it.  The only other option is lithium which as its own problems.

advice here is very helpful.

do you really think an MAOI is gold standard here?

MAOi has been consistently proven effective in atypical depression and in anxiety-related conditions (social anxiety in particular). I think you should discuss it with your psychiatrist. In my opinion taking a medication with a strong anti-anxiety profile is always a better choice than taking antipsychotics (when not necessary).

Yes, you are right with that, antipsychotics would be my last choice especially as i do not have bipolar, im down rather than up, and feeling antisocial.

someone suggested that the good old lithium would perhaps help, or lamictal.   What is your view?

Ann, lithium and lamictal? are mood stabilisers. As you said - you don't suffer from bipolar disorder so... do you really need any kind of chemical mood stabilisation? I think you need a medication that would help with the anxiety and - taking into account all information that you provided earlier - I would suggest trying phenelzine (Nardil). If you can follow the dietary restrictions, it should help you. It is a drug of last resort, it is used when all other treatements failed. Yes, you would need to be super careful about the stuff you eat, but on the other hand - no other antidepressant has been ever demonstrated to be superior to phenelzine (despite it being around for the last 60 years or so).

Thanks once again. You give sound advice.  I need to discuss this in depth with psychand hope he agrees with you.

i have been feeling terrible since i dropppd the risperidone last week, its as if it hasnt left my system yet, tired and just ill.

i am having to take diazepam 2mg to get me through the day over the last year, and 5mg to sleep.  I really want off it too but so anxious cant domit.  I would hope the right a/d would help

I can see why this drug is not prescribed often, the side effect profile is huge and very concerning.  I cant imagine my psych will use it.  

I have asked for feedback from others whomuse it but have not had even one reply, younare right, it must be used very seldom nowadays.

I have readr ken gillmans articles on line regarding maos and he said Parnate may suit. Look forward to your comments.  Still no response from anyone else on maois.

Hi Ann,

Have a look at this paper:

The successful stories are out there, but their numbers are limited as MAOis are so rarely used these days. In UK both - Parnate and Nardil - have to be prescribed by a consultant psychiatrist. GPs cannot start people on these medications (NICE guidelines...) and we both know how easy it is to get an appointment with a pdoc...

From what I know, in addition to the antidepressant effect, Nardil seems to help more with the anxiety, social anxiety in particular, due to its unique action on the GABA receptors. In some way its effect is similar to benzodiazepines, but it does not produce addiction following long term use. Why? No one knows. But hey, why would you invest in doing research on this topic, while so many benzodiazepines are available and patients are happy to take them...?

Parnate is more activating, which may not be very good for anxiety symptoms. On the other hand some reports contradict this, saying that it helped with GAD while no other therapy (including ECT) was successful.

I guess the conclusion is that you just need to find an experienced psychiatrist who would be more concerned about your condition than his/her career (imagine the consequences for the prescriber if something happened to you - all questions would be asked, including why did he/she use this particular group of medications while safer alternatives have been available).

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Thanks again - will definitely ask next week at consultant psychiatrist appt. he is young, not long in post and has tried sertraline, anti psychotics and has my file from year before when i tried many.  I do hope hes not against the nardil but will have to see.  Any other thoughts always welcome

Having researched this i am concerned that as i have an agitated form of depression the nardil may make this worse.  Is this true?