Risperdal Disaster? Feeling like crap again.

[AnxiouSteve]

I've made a blog entry yesterday for those unfamiliar with my case, so I can keep the background info brief:  It's here.

Brief Background:
After this started in late October I had a rough go about it for the first few weeks.  I saw a Neurologist about random twitching who gave me great reassurance, and a psychiatrist who began medicating me.  Then by December I felt fine.  Still a little nervous.  Hypochondria still on the back of my mind, but a lot better.  I didn't feel mentally sick, and didn't worry about being physically sick.

Toward the end of January I went to see the p-doc, and just like last month I told him I was feeling a lot better for the second time.  He had weaned me last visit from 150mg/day of Seroquel to 100mg/day in one shot.  I wanted to be off the AAPs so in the following weeks I had weaned myself down to 50mg/day. 

Misadventures with Atypical Antipsychotics
He had asked me about Risperdal last visit, but I was hesitant.  He told me to look into it.  This visit I told him to do whatever he wanted with me, as he was the expert.  So he put me on a low dose of Risperdal (.5mg/day), and told me to stop taking the Seroquel.  I told him I would one again see him in a month.  I was wrong.

The first day I was nauseous as hell.  It could have been a questionable ham sandwich I ate the night prior.  For the first week all I noticed was a little itchiness.  Seroquel has a greater affinity for the histamine receptor than does Risperdal.  However, I find myself taking a benzo daily again.  At first I just thought I was being irresponsible.  I had not taken them for days prior to the visit.  Despite their relatively long half-life I came up clean for them when the p-doc drug-tested me.  (I used to smoke pot and all his other patients are drug addicts, so I guess he's fixated on whether I'm lying to him about no longer smoking.)

The second week I started having bad thoughts again.  I notice my shoulder, like a lot of joints in my body makes this popping sound when I move it a certain way.  I knew it was probably nothing, but I couldn't help but wonder if it wasn't caused by some muscle wasting in my shoulder joint.  I did a new exercise at the gym on Wednesday.  On Friday I was sore, but I'm still bothered that I was able to do less reps...  and does my voice sound hoarse to you?  That could be ALS as well.  It feels weak to me, and I feel speaking is more difficult...  Here we go again.

Now, one of the more common side-effects of Risperdal is anxiety, so that might have done it.  With that in mind, I called the P-Doc and told him my anxiety had gotten worse all of a sudden.  He told me to come in and asked what I wanted him to do.  I said that he should do whatever is best.

Semi-Emergency visit to p-doc
That's when the guy asked me about Haldol, a traditional AntiPsychotic (whereas Seroquel and Risperdal are a typical).  They are known for having even more side-effects than the Atypicals, and a much greater likelihood of getting the permanent kind.  It was either that or Neurontin (Gabapentin), a swiss-army antiepileptic medication.  I went with 100mg of Neurontin twice a day.  It's well under the normal maintenance dose when used for Anxiety...  Come to think of it, so is the 20mg/day Inderal which he gave me, so in a sense I'm almost non-medicated right now, except...

I decided to take .25mg/night of left over Seroquel, despite the fact that he thought I should go cold turkey on the AAPs.  I'll wean off of that the moment I feel better.

The next day I was determined to feel better, so I started writing that blog post that I linked to above.  That's when I started to get a twitch in my shoulder.  It wasn't like the old twitches which scared me so bad to begin with, and have basically gone away.  Those would be brief, and usually in my legs.  If I touched the skin they would go away.  If I pulled up my pant leg they would be gone.  Flexing the muscle one would usually cancel it out.  Flexing it twice definitely would.

This one still stopped when I flexed (thank God), but it just came right back.  Looking at it didn't make it stop, either.  In many senses this was a 'normal muscle twitch' whereas the ones I had before were atypical, but it still scared the crap outta me.  "It's probably the lifting or the new Neurontin," I told myself.  Twitching is a side-effect in a mere 1.7% of patients according to premarketing trials, but still...  I Googled some more.  I Googled just enough to get an equal dose of reassurance and fright.  So much for Googling responsibly.

At 5pm I decided it wsa early enough to take half (.125mg) a Xanax and a drink a Vodka Tonic, and sure enough it went away.  I guess we can at least say that anxiety made it worse.

So, what now?
I'd been lax on all the herbal / supplemental treatments (besides Kava) that I spent so much time researching, but that has changed now.  I've reordered Sam-E and Inositol, which I'd run out of.  I've also ordered Phenibut for situational anxiety and Piratacem to prevent tolerance to the former (Interesting stuff, you should google it).

So I'm back on the horse.  It's not as bad as in the beginning (no panic attacks), but it ain't great either.

As always, any thoughts, questions, concerns are much appreciated.

[studdmuffin]

one of the side effects of haldol is uncontrollable drooling.

a think a doctor has to be a litle psychotic to prescribe that.

[AnxiouSteve]

I found someone to give me a second opinion.  I like my current guy, but there are a few little things that bother me.

• He seems to forget what medications I'm on.
• He seems to forget things that I tell him.
• I tell him I'm feeling better so he decides to either add meds or switch them.
• He likes the anti psychotics a bit too much, while not wanting to give me Buspar
• His office is a total sty, and it's in the middle of the ghetto (still don't know what circa 1978 typewriter is for).
• He seems to run a methadone clinic, primarily.
• He doesn't work by appointment, everyone just shows up and gets their meds in 15 minutes like a junkie sh!t-storm
• He seems scattered and disorganized.

[AnxiouSteve]

Almost forgot one of the more important reasons I'm starting to get annoyed with this guy:  If you're going to give me a beta-blocker and an antiepileptic, can you at least give it to me in a dosage that is useful for anxiety?

According to Wikipedia I should be taking 10-40 mg 3-4 times a day for Anxiety.  That gives a range of 30 to 160 mg, meaning I'm taking 50% to 800% less than that. 

He gives me this stuff when I tell him I'm feeling fine, then it does nothing for me now that I actually need it.  At one point this guy told me to take three a day because I complained that a home BP test came consistently high (140/90, but turned out the test was inaccurate), and then he writes me an Rx for two a day again.

Similarly, he gives me Gabapentin 0213 100mg x 2/day x 30 days, when from everything I've read 300 - 1200 mg /day  is the normal dose for Anxiety.  I'm all for titrating the dose, but give me some flexibility to get at least up to an effective dose within 30 days.  Do I have the world's mildest anxiety, or something?  If the guy knows anything about me by now, it should at least be that I don't over medicate, and if anything I under medicate.