gregrob: Tapering from Risperdal

[gregrob]

I'm new to the forums - currently taking 225mg Effexor, .25mg Klonopin, and .25mg Risperdal. My psychiatrist noted that the Risperdal is temporary (will be taking it for about 3 months), but after reading about withdrawal from this particular drug, I'm wondering if I shouldn't begin going off it sooner than that. It's worth noting that the depression and anxiety that I was experiencing even with Effexor and Klonopin did subside almost immediately after beginning Risperdal.

 

At any rate, I already know I'll be beginning a taper off Klonopin soon, after successfully dropping from .5mg to .25mg without any side effects after 4 weeks - I think I got lucky there.

 

I've been on Risperdal for 28 days, so my natural question, given that withdrawal from psychiatric drugs can occur for anyone taking them for "1 month or longer" is whether I should just stop immediately, since it's been just shy of one month and my dose is low, or if I should taper. I understand that I shouldn't expect a definitive answer to this, but I'm very interested to hear what others think and, quite frankly, very scared about what I'm about to face, given the need to taper from two different drugs.

 

My psychiatrist will undoubtedly tell me to just stop taking it after I've been on it for 3 months, as she seems to believe that there are no withdrawal symptoms from any psych. drugs. So I kind of have to go it alone on this decision without guidance from her. Any thoughts would be much appreciated.

 

 

[scallywag]

gregrob -- Welcome to Surviving Antidepressants (SA)

 

It's very smart of you to have investigated methods to discontinue Risperdal and other medications before you got too far down a steep and rocky path. You have indeed been lucky that a 50% reduction in Klonopin has been symptom-free.

 

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs.
• Link to Account Settings – Create or Edit a signature.
   

The decision to stop taking risperidone (Risperdal) earlier than your doctor advises is yours to make. Certainly the longer one takes a neuro-psycho-active drug, the slower the taper off seems to need to be. Suddenly stopping is not a good idea at this point, particularly because you mention that you've noticed an effect from taking it (improved mood). If you want to discontinue, you could try a 20-25% reduction, taking 0.18 - 0.2 mg risperidone for 10-14 days to see how your CNS (central nervous system) responds to the change. 

 

Please note that it is not a good idea to make large dose adjustments in two drugs at the same time. So pick either the benzo (clonazepam/klonopin) or risperidone. Some important information for you to read:

 

What is withdrawal syndrome.

Before you begin tapering -- what you need to know.

Why taper by 10% of my dosage?.

Tips for tapering off Risperdal (risperidone)

Ashton and beyond in benzo tapering 

 

What symptoms, if any, are you having now? Managing a taper is much easier when you keep track of symptoms. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

Also, many people find the list in this topic, downloadable files are in the first post, helpful as a tool in tracking symptoms: Glenmullen’s withdrawal symptom list.

 

Have a look at the links I've posted and post a signature with your medication history and current doses.  I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

Edited July 8, 2017 by scallywag
correct typo that could have been confusing

[gregrob]

Thank you Scallywag - I've updated my signature, though I don't have exact dates (I did the best I could).

 

Also - while I thought I was about to begin a Klonopin taper, a bit more research led me to decide to start with the Risperdal first. I've got my Klonopin taper planned, and it looks like it will take about 7 months to go from .25mg to a "jumping off" point. However, I've got more research to do and I'm DEFINITELY not going to start with that until I'm entirely off the Risperdal. I will likely give myself several weeks between when I feel "better" off the Risperdal and when I begin the Klonopin taper.

 

At present, I'm exhibiting two symptoms: 1) a bit of jitters, for lack of a better term. I believe this actually *is* a symptom of dropping down the Klonopin. I'm taking Effexor, as you'll see in my signature, and it made me feel this way sometimes when I took my daily dose of Klonopin later than usual. I think the Klonopin "knocked down" the slightly jittery feeling that Effexor can give me. 2) anxiety that I'm on Risperdal in the first place. This isn't generalized anxiety - just scared about the road ahead, which looks like it will be a year of tapering one medication after another. I'm really, really scared, in fact. But I'm happy to have SA here to help me through.

 

Thanks again.

[scallywag]

gregrob,  Thanks for posting your signature. Now that we know you're taking 4 medications and recently switched from Lexapro to Effexor,  I'm going to ask other moderators to have a look at your situation. Are you willing to hold steady where you are with your doses for a few days while this review takes place behind the scenes?

 

It will help us help you to see a few days' notes of your doses and symptoms. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

When a someone is taking multiple medications, we ask that that you post an interactions report.  Follow the link below to get your report. Just select the text, copy it and paste it in a post here.

Drugs-dot-com Drugs Interactions Checker.

 

Some questions for you:

1. Do you recall why Lexapro was increased from 15 mg to 20 mg in January?
2. Why did you start taking clonazepam (klonopin) in January?
3. What prompted the switch from Lexapro to Effexor in May?
4. Was the switch a cross-over where dose of L was decreased over a few weeks while E dose was increased, or was it a cold overnight stop L + start E?
5. Your doc switched you to Effexor and added Trazodone at the same time.  Do you remember what her thinking was for that?

It's likely that the switch in May from Lexapro to Effexor has left your CNS (central nervous system) in somewhat of an uproar.  To understand what I mean, have a look at these explanations:

How your brain responds to psychiatric drugs - aka "Brain remodeling"

Youtube video, 4 minutes: Healing from antidepressants

 

Although escitalopram (Lexapro) and venlafaxine (Effexor) are both anti-depressants, they don't affect serotonin receptors in quite the same way. Switching medications can be as destabilizing as a drastic reduction of a medication because a switch is really 100% discontinuation + replacement. You had symptoms after the switch, right?  Your doc added risperidone was to treat those symptoms.  In other words,  your doctor advised a drug to treat a problem caused by her advice about another drug.

 

And, for most people doses of Effexor above 150 mg start to affect the norepinephrine receptors in addition to the serotonin receptors.  If you're up for reading a psychiatrist's irreverent explanation of this, please read: The Last Psychiatrist: No, Not Effexor Too!?.  That is Part 2 of a 3-part series, here's the first: The Last Psychiatrist: The Most Important Article on Psychiatry You Will Ever Read.

 

 

[gregrob]

Scallywag - I will absolutely hold at my current dosages until there's been a chance for the mods to look at the situation. I'll also post my meds/doses/times starting tomorrow - with today's information. Along with that, I'll make another post of interactions, but I have a question about that - do you mean to type in one medication, and then copy/paste the entire interaction report, then type in the second medication and copy/paste that entire interaction report, etc.? If I'm missing something there, please let me know.

 

- Lexapro was increased to 20mg during a major depressive episode that left me hospitalized

- I started taking Klonopin at the same time, prescribed by the same hospital doctor who increased Lexapro

- I also started taking Abilify at the same time, again prescribed by the hospital doctor (sorry - forgot about the Abilify, and added that into my signature)

- My outpatient psychiatrist switched me from Lexapro to Effexor in May because I was not responding to the Lexapro/Abilify/Klonopin cocktail. She had me stop the Abilify cold turkey. I was again hospitalized in May and while there the cross-titration of Lexapro/Effexor was sped up dramatically. They did this over the course of 4 days.

- The Trazodone was added by the hospital doctor in May to help with sleep, then continued by my outpatient psychiatrist. I couldn't even sniff sleep without taking this - presumably the result of the Effexor.

 

I haven't read the material you've linked to yet because I'm feeling a bit fragile at this particular moment and need to get my mind off of this for a little bit. I can say, however, that the dose of Effexor over 150mg was done intentionally to bring norepinephrine receptors into the mix (to treat generalized anxiety disorder, I believe).

 

 

[scallywag]

Greg -- please enter all medications you're taking into the interactions checker at the same time.  The interactions can only be listed if all drugs are included as inputs.

[gregrob]

Here are the interactions:

 

Interactions between your selected drugs

Major

trazodone  venlafaxine

Applies to: trazodone, Effexor XR (venlafaxine)

Using traZODone together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  trazodone

Applies to: Klonopin (clonazepam), trazodone

Using clonazePAM together with traZODone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  risperidone

Applies to: Klonopin (clonazepam), Risperdal (risperidone)

Using clonazePAM together with risperiDONE may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

trazodone  risperidone

Applies to: trazodone, Risperdal (risperidone)

Using traZODone together with risperiDONE can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  venlafaxine

Applies to: Klonopin (clonazepam), Effexor XR (venlafaxine)

Using clonazePAM together with venlafaxine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

risperidone  venlafaxine

Applies to: Risperdal (risperidone), Effexor XR (venlafaxine)

Using risperiDONE together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[gregrob]

Here is my journal from yesterday through this morning (because I couldn't sleep).

 

NOTE: a few days ago I felt fine. Now I feel really, really terrible. I'm beginning to think that going from .5mg Klonopin to .25mg is just now starting to catch up with me. It's been 3 weeks and a couple days (not 4 weeks as I initially though) and it's just not good.

 

Forgive me for the disjointed nature of this journal - I'll get better with practice:

 

7/8/2017 - morning of 7/9/2017

6:30 A.M. - woke

7:20 A.M. - drank coffee + fruit for light breakfast

7:50 A.M. - ran 5.3 miles

DURING RUN - felt "not present" at times, with a feeling like my head was light or "buzzy"

9:30 A.M. - at full breakfast, took 225mg Effexor

11AM-1:30PM (roughly) - felt somewhat jittery, not physical jitters, but internal feeling

4:15 PM - took .25mg Klonopin

8:00 PM - took .25mg Risperdal

10:10 PM - feel asleep

1:16 AM - woke up

1:16 AM - 6 AM - tried to fall back asleep unsuccessfully, felt warmth in chest and arms, anxiety, dark thoughts

4:30 AM - took another .25mg Klonopin to try to ease anxiety and fall asleep

7:00 AM - anxiety, panic, crying

[mammaP]

Hi Gregrob, I just looked at your topic and you are thinking about tapering risperdal because you have been on it for a short time. While that may be true you were taken off abilify cold turkey and it was replaced by risperdal.  Risperdal is helping with the side effects of effexor which seems to be too activating for you and might be best to be reduced first. I would hold on the klonopin, which will also be helping with the side effects.  At the moment your nervous system is are unstable because of all these changes. For now it might be best not to change anything until you feel more stable, then start to reduce the effexor. You will be feeling the klonopin cut too. Changing too many things sends our poor brains into a spin and it needs some stability. When do you take trazodone? I can't see it in your journal, which is very helpful. 

[gregrob]

Sorry - Trazodone was taken at roughly 9 PM that day, but I missed it in my sloppy notes.

 

What I started doing as of 7/9 (evening) is taking the original .5mg dose of Klonopin that I was prescribed. I'm doing as you suggested and waiting to taper the Klonopin, and taking the full dose because I think it will help me with side effects from tapering other meds and also reduce/eliminate the side effects of dropping to .25mg too quickly.

 

On the Risperdol - a big reason I want to start to taper this (first) is the potentially terrible side effects that I'm almost afraid to read further about. I'd like to get this out of my system and find out how the Effexor is really making me feel. When (not if) I go off Effexor, I'm going to try cross-titration with Prozac, which I've heard is the best SSRI to use to get off Effexor.

 

So your suggestion seems to be to do the reverse of what I'm doing - Effexor first, then Risperdal. I also see that you have experience going of Effexor. I've heard it's horrendous and thus wanted to use Prozac to ease the process. I think I can take the effects of Effexor being too activating for a while, but that hell may push me to go for a Prozac cross-titration sooner rather than later after getting off the Risperdal.

 

I don't know if this runs counter to the ethos of SA, but I don't think I'll ever be entirely off antidepressants. I'd be very happy to simply be on a single SSRI that works for me, as Celexa and Lexapro did for 19 years.

 

Anyway - I'm rambling now. I would love to know more about your experience tapering Effexor, and why you chose to do a straight taper rather than cross-titration. Another thing I'm worried about is the interaction between Effexor and Trazodone. It's apparently rare, but the results are catastrophic. Sometimes I don't even think I should read about any of those, and just work to get off the meds with my head down and spirits as high as I can keep them.

 

Again, I know I'm rambling, but if anything I've written elicits any thoughts, please let me know. As noted, I've spent most of my diagnosed life with a very simple medication list - this complex list and need to do tapers is confusing and a bit scary.

[scallywag]

gregrob - mammaP suggested that you reduce the Effexor to reduce the stimulating effect that it is having.  At doses above 150 mg, the "N" part of Effexor's SNRI comes into play; N = norepinephrine. 

 

Reducing by 10% per month would decrease your dose to 112.5 in 6 months.  Maybe at that point when you're not getting the "N" hit from Effexor, it would be worth considering reducing either the Risperdal or trazodone dose by half.

[gregrob]

Scallywag - thanks for the reply. I'm in an odd situation - I was starting to have frightening physical side effects, potentially from the Risperdal, but perhaps more likely from the combination of Effexor and Trazodone (which can cause serotonin syndrome). A clinical pharmacist who is a friend of the family created a Risperdal tapering plan for me and I had that confirmed by a friend with a medical degree who had to taper two of her children off large doses of Risperdal (bi-polar). It was a quick taper by the standards of SA and I'm now 5 days in without taking Rispderdal at all. I stopped the Trazodone immediately once some symptoms consistent with serotonin syndrome presented. This isn't what I wanted to do, but I simply became too scared to continue taking either of them.

 

SO FAR (and I stress that), all is well. Each day that passes I brace for something bad to happen, but with each passing day I also become more comfortable with beginning to believe that this part of my med regime is safely behind me. Other than some minor headaches and trouble sleeping, I'm having no symptoms. I exercise intensely each day, have an impeccable diet that is full of fruits and vegetables, and support from family and friends that sometimes is hard to fathom.

 

I'm going to post in more depth here once I really know what's going on. I'm also talking to a new psychiatrist soon who appears to be well respected and fully acknowledges the need to slowly taper off Benzos (unlike my now-former psych.). I will detail every experience I have with the Benzo taper/withdrawal, along with continuing to update on what becomes of my relationship with Effexor (whether tapering down or cross-titrating off).