Spotlight: Risperidone (Risperdal)

It’s time for another med review, this time of the atypical antipsychotic drug risperidone (/Risperdal). As ever, please remember that this post is based purely on my experience of this med, and that it may work differently for different people. Image

My psychiatrist introduced me to risperidone after I found olanzapine (Zyprexa) and quetiapine (Seroquel) to be of little use in conjunction with the 60mg of fluoxetine (Prozac) I had been taking for months. He was sure an antipsychotic paired with my antidepressants would work miracles for me, but knew I was nervous about side effects given my back luck with the previous drugs. He told me risperidone was a lot milder. Private research kept me worried though; even if it didn’t massively boost my appetite like the olanzapine, I found studies that showed this med increases weight in the long term by causing the body to increase fat storage. But my depression was persistent enough that I agreed to give it a go.

After having an ECG and blood tests to give me an ‘all clear’, I picked up a prescription for 0.5mg taken nightly. That dose had me sleeping a lot better, and a few days later I was bumped up to 1mg. I wrote the following in my journal:

…this has me feeling kind of drunk – like my movements don’t match up with quite what I’m seeing, so I can’t really walk in a very straight line, and I don’t feel particularly stable.

So at 1mg nightly I would sleep like a log, and then wake up the next morning feeling drowsy and wobbly. The drowsiness always wore off after an hour or so, but the instability didn’t. When I stood up the world would spin, without fail. Usually I’d just wait for it to pass, but sometimes I’d begin to black out, and I nearly fainted a couple of times. When I informed my GP he assured me that the risperidone wasn’t responsible, because ‘it used to be prescribed all the time ten years ago’ and he ‘never had a case like this’.

A few weeks later my depression hadn’t really improved, and sleeping problems were starting to creep back in, so it was decided that it was time to start taking 2mg risperidone each night. Two days later I nearly passed out in a supermarket. And at this dose I found my appetite beginning to soar. In my journal there’s a little debate about whether or not to keep taking risperidone, which went as follows:

Reasons to stop taking it: lose my appetite and get control back on eating, reduce dizziness 

Reasons to keep taking them: marginal help with sleep, mood stabilizing effect, withdrawal symptoms

I’m kind of ashamed that my main reason for not taking it was diet-related, but maybe that isn’t surprising given my strange relationship with food and weight. Anyway, I stopped, and the next day my GP pushed me very hard to keep going with it because ‘we’re almost out of therapeutic options here’, he wasn’t happy to leave me taking only fluoxetine because he remembered the ‘dark times’, and said the dizziness situation would sort itself out with time. He gave me another prescription in high hopes I would take it. After discussing it with my therapist (who was irritatingly neutral), I binned it.

I haven’t had any issues with dizziness since I stopped taking risperidone, so I’m pretty sure the med was to blame. I experienced something similar with quetiapine (Seroquel), so I guess it’s possible that I have a strange reaction to atypical antipsychotics.

Summary

Doses: 0.5mg, 1mg, 2mg

Positives: I slept really well on this medication, and I found my mood stabilized over the period I was taking it.

Negatives: Dizziness every time I stood up, occasionally to the point of losing vision. Increased appetite when taking 2mg daily

Conclusion: I was grateful to have improved sleep since I struggle with insomnia, but ultimately it did little for my depression beyond stabilizing my lows. It certainly wasn’t worth the difficulties caused by persistent dizziness, or weight gain. Not the med for me.

Venlafaxine withdrawal: The horror stories are TRUE

It’s day two of going cold turkey from the 300mg daily dose of venlafaxine XR (/Effexor), and despite the reassurances from my GP on Friday I can confirm the horror stories are turning out to be true.

Last night was strange – I had lots of strong dreams, and at one point during the night I woke up shaking pretty violently. I also felt sick so I emptied my bin and placed it next to my bed just in case. Today I’ve had relatives over for lunch so I’ve had to put on a bit of a show of being fine, but I had to take a few minutes to sneak away and keep my head between my knees, waiting for some dizziness to fade. I’ve also been close to crying on a couple of occasions, which is weird for me. At first I thought it was because I feel so strange, but I now reckon it has more to do with withdrawal-related emotional instability.

Rather than posting loads on the same topic, I’ll update this post semi-regularly over the next few days with how I’m getting on. Fingers crossed the worst will be over by Christmas…

Update: 23/12 – Today has been better and worse – better in that I feel more emotionally stable, but worse because I’ve been shaking non-stop all day, regardless of temperature. I’m more than happy to live with it though; I’d much rather shake like I’m sitting in a bath filled with ice than mooch around feeling sick and miserable. I’m not worried about how this might affect Christmas, and I’m hopeful that I’m over the worst of the withdrawal.

Update: 25/12 – The shakes stuck with me for most of yesterday, but they seemed to have vanished for Christmas! I’ve actually felt pretty much normal for most of today, and it’s only as the evening has drawn in that I’ve started feeling buzzy again. My coordination is back to standard, which means I’ve been able to drive today for the first time in a little while.

Update: 30/12 – I’ve been off venlafaxine for over a week now, and I think I’m clear of withdrawal symptoms. I haven’t had any brain zaps in a while, and I think I can safely sign off on any shaking being more cold-related than anything else now.

A bit of a medication mess

I saw my GP this afternoon, and we agreed that venlafaxine (Effexor) isn’t working out for me. I’ve been on it for over three months now, on a high dose of 300mg daily for at least a third of that time, and yet I still end up feeling low and self-harming etc.

The big question was what to try next; if you’ve seen my ‘about’ page you’ll know I’ve tried quite a number of different meds with little success. Last time I saw my psychiatrist he said the next step would be to either add mirtazapine into the mix (a combo worryingly known as ‘Californian Rocket Fuel’), or switch to a different AD altogether. My GP opted for the first and cut me down to 150mg venlafaxine each morning, with 15mg of mirtazapine to be taken each night. He also assured me that I shouldn’t take the horror stories I’ve read online about venlafaxine withdrawal too seriously (we shall see…)

However, when I arrived at the pharmacy a little later and actually read the prescription my GP had given me, I realised he wasn’t giving me any more venlafaxine, and I only have a couple of 150mg tablets left. My mistake; I shouldn’t have assumed he’d know to give me more (although he usually does. Never mind). It would have been a hassle to go back, so I’ve rather bravely (?) decided to collect up whatever pills I have left (a couple of 150s, some 225s and some 75s) and wean myself off completely over the course of the next week or two. I hope my GP was right about the withdrawal symptoms horror stories being exaggerated because otherwise Christmas isn’t going to be a lot of fun.

Initially I was quite pleased about having mirtazapine again because it should help me sleep, but I’ve remembered that weight gain is a common side effect. Well, I guess if venlafaxine withdrawal has me feeling sick the two might balance each other out!

Spotlight: Venlafaxine (Effexor)

ImageFor the second instalment of medication reviews I’m jumping forward in time to my most recent prescription – venlafaxine, alternatively known as EffexorAs before please bear in mind that this post is only describing my experience of the drug – it may work differently for other people.

Following the failures of three antipsychotics and fluoxetine to make much of a dent in my depression, my psychiatrist decided I should try venlafaxine, beginning with 75mg a day. At first I noticed feeling quite nauseated, and unfortunately it wasn’t making me sleep any better (not that it was supposed to, but it would have been a bonus!). When I started taking venlafaxine I was in the middle of quite an unstable period mood-wise, and nothing changed in the month we gave it to get working so my GP upped the dose to 150mg (slow release). This was pushed up to 225mg by my psychiatrist at my 6 week review, and as my DSH and suicide ideation persisted I eventually ended up on the dose I take at the moment, 300mg. I’m pleased to say the sickness didn’t last more than a week or so, and apart from that there haven’t been any noticeable side effects. On the other hand, I can’t really say I’ve seen any significant effect on my mood; I have the same ups and downs over time, and can’t imagine feeling worse off without these pills.

However there is something I think anyone considering taking venlafaxine should be aware of: this medication is one of the nastiest I’ve come across in terms of side effects when coming off it. When my psychiatrist first mentioned venlafaxine I did some research and straight away found hundreds comments from patients about the hell they went through when they weaned themselves off it, and with my experience I would bet money that they aren’t exaggerating. Venlafaxine has a short half life which means it leaves your body relatively quickly, and the significance of this is that if you are late taking a dose or miss it, you feel the withdrawal effects faster than you would on say, fluoxetine (Prozac). Being a bit of a curious idiot I decided to go without my meds for a while to see if it was as bad as I’d read, and I can safely say I won’t be doing that again. I lasted 48 hours, during which I had some serious brain zaps, light-headedness, and nausea. Given that venlafaxine doesn’t seem to be doing me many favours I expect my psychiatrist will take me off it after my next review in January, and if I’m honest that’s scaring me a bit given I’m on the highest dose. I plan to come down very slowly, and take some of my leftover fluoxetine to try and dampen the withdrawal symptoms.

Update (30/12/13): After a bit of a prescription mix up I ended up quitting venlafaxine cold turkey, and the week that followed was not fun. I felt sick, my brain buzzed and zapped constantly for two days and then gradually calmed down, I shook violently for quite a long time, and I was very emotionally unstable. That said, it could have been worse – the nausea wore off reasonably fast, and although the shakes and zaps were annoying, I wasn’t bed-ridden. For more detail please see some of my later blog posts.

Summary

Doses (daily): 75mg, 150mg (XR), 225mg (XR), 300mg (XR)

Positive effects: None

Negative effects: Initial nausea, although it wasn’t a big problem because it went away after a week. My real issue with this med is how ill it makes me feel if I forget to take it within a couple of hours of my usual time.

Conclusion: Not the antidepressant for me, and trying it out cost me a lot when the time came to stop taking it. I would seriously recommend having a good think about what you’re potentially committing to if you’re considering starting venlafaxine.