[CobolCapsule]

I saw my doctor today, and told him I was becoming occasionally irritable at 1mg of risperidone since lowering the dosage. I said I think I need to stay at 1mg, because of the occasional irritability, and he said he is going to lower my dosage in half to .5mg.
I have tried cutting my dosage in half all at once before, and could not sleep but a few hours. So now he wants me to half my dosage, and lose lots of sleep, and I am sure I'll become more irritable do to lack of sleep, plus taking a lower dosage of risperidone.
I use the VA, and was able to call to check on my new script to be mailed, and they are sending me .5's. I thought he would at least let me taper to .5 slowly, but now I'll be stuck with .5's without tapering.
I told him I shouldn't go lower than 1mg, and he just ignored me basically.
His only way of diagnosing bipolar was to ask me if I stay up all night, and I think that is ridiculous.
I've had what i would say are mixed states before risperidone, and I'm stuck with this idiot of a Dr who only diagnoses bipolar one way.

What should I do?

Thanks for any feedback

[Moose72]

Staying up all night- how many days in a row- and did you feel completely refreshed? There are lots of symptoms to bipolar not just a sleepless night.

[CobolCapsule]

Staying up all night is something I just haven't done, and I know that can't be the only way of diagnosing bipolar. Prior to neuroleptics I would have bursts of energy being overly excited, followed by extreme lack of energy and feeling gloom, then followed by having lots of energy and irritability and dull intellect, and I would have low energy moments with high intellect with irritability.
I would have the combination of high intellect, hyper energy, irritability, sadness, low energy, low intellect, and energy with sadness in all mixed states.

[Moose72]

Why not read a bit of my blog (in signature) and see if any of it rings any bells?

[cashart10]

Is your diagnosis in contention? Or just the meds? Did he give you a reason for the med adjustment? It sounds strange. Do you have the means to see another doctor? I also would find that odd.

[CobolCapsule]

Thanks moose72 for introducing me to your blog. I plan to follow it, for I just registered my email with it.
I can relate quite well to what I've read so far. The meanness of mania hit quite well with me especially.

[CobolCapsule]

Cashart10
There really was no disagreement with the diagnosis, for I accepted his one symptom for diagnosis. I didn't want to argue with him, and he gave me no reason for lowering my dosage. The VA is basically my insurance, so I would have to pay out of pocket for another Dr.

[Moose72]

Originally Posted by CobolCapsule

Thanks moose72 for introducing me to your blog. I plan to follow it, for I just registered my email with it.
I can relate quite well to what I've read so far. The meanness of mania hit quite well with me especially.

You're welcome! And I hope you enjoy and find it helpful .

[CobolCapsule]

I do remember my Dr telling me .5mg is safer than 1mg, which sounded ridiculous to me since both are very low doses. How dumb is my Dr?

[Moose72]

Originally Posted by CobolCapsule

I do remember my Dr telling me .5mg is safer than 1mg, which sounded ridiculous to me since both are very low doses. How dumb is my Dr?

Well I guess less of something could be safer. However would you take less poison because it was less?

[CobolCapsule]

Well I guess less of something could be safer. However would you take less poison because it was less?

So basically your saying my Dr is an idiot?

Maybe I'll try giving his assistant a call tomorrow, and tell her I'm more comfortable at 1mg, and to have him refill my script for that.

[still_crazy]

psychiatrists are an odd bunch. For all this talk of how scientific mental health treatment is, they're basically just throwing pills at us and hoping things get better ((assuming they care. lots of doctors don't)).

Maybe your doctor thinks you're ready for .5 and can handle your emotions without a tranquilizer? Maybe he's worried about weight gain, prolactin, tardive dyskinesia, etc.?

Its interesting, how docs approach neuroleptics. I had this one old, old, old school shrink--Southern, finished residency in the early 60s. He told me to take more Abilify because it would "work better." Well, 4 years later, I have a new doctor who is talking dosage reduction and, at long last, an AIMS test.

Point is...psychiatry isn't scientific. The better doctors do what they can, but you're dealing with life, emotions, the interplay of individuals+families+society, etc. There's a level of complexity and nuance to the whole thing, so I'd personally try to cut your prescriber a little bit of slack. At least he's not ramping up the dose and tranquilizing you into oblivion.

[CobolCapsule]

Basically I told my Dr I was becoming a little more irritable at 1mg, but he insisted on me lowering my dosage.

Aren't weight gain, elevated prolactin levels and TD dose dependent?
My research tells me they are.

Isn't 1 mg considered to be a low dose, and is it safe at that dosage?

[emgreen]

Risperidone can have some pretty embarrassing side-effects for men, including breast development, sensitive nipples & lactation. Sorry...I don't know if you're a man or woman, but thought I'd throw that in there. Is it possible for your pdoc to put you on another med that will give you the relief you seek?

[CobolCapsule]

Risperidone can have some pretty embarrassing side-effects for men, including breast development, sensitive nipples & lactation. Sorry...I don't know if you're a man or woman, but thought I'd throw that in there. Is it possible for your pdoc to put you on another med that will give you the relief you seek?

Risperidone is associated with dose-dependent prolactin elevation, so Gynecomastia is likely to happen at higher doses with risperiodone, and i have not had any problems like you stated above, even when i was at 3mg which is still a low dose. Most people dont get that side effect, for dugs.com says .1-1% get Gynecomastia.

[emgreen]

Sorry about the alarmist post.

[CobolCapsule]

Sorry about the alarmist post.

No problem... i just thought i would state some facts about the drug. It was the go to drug the last time i was hospitalized, for everyone was on risperidone.

[CobolCapsule]

Recently i have had moments of irritability and moments of optimism followed by moments of pessimism. This has happened ever since i got down to 1mg of risperidone. There not extreme moments like i had prior to taking risperidone, but they are there.

I really don't think i should halve my dosage like he wants me to.

Every test i take on the internet tells me i have bipolar disorder. I don't know why my doctor has a one symptom diagnosis.
I left a message with his assistant to give me a call today.

[Trippin2.0]

I lactated on 0.5mg, so I call bullshyt on side effects being dose dependent.

Also, there are studies that link long term AP usage with brain atrophy...

So if I needed one long term, I would personally have as little of it as possible, and try and manage whatever it doesn't cover, like my former rage problem, by some other means.

[CobolCapsule]

I lactated on 0.5mg, so I call bullshyt on side effects being dose dependent.

Also, there are studies that link long term AP usage with brain atrophy...

So if I needed one long term, I would personally have as little of it as possible, and try and manage whatever it doesn't cover, like my former rage problem, by some other means

I am not saying every person at any dosage isn't going to experience some side effects. The chances just increase with higher dosage. The fact that you had problems with a .5mg dose, puts you in the extreme minority.
As far brain atrophy risperidone has been shown to increase the grey matter in the brain with long term use, making it pro cognitive.

[Shazerac]

If you end up not being ok wth the half dose maybe you could just tell the idiot what he wants to hear. Tell him the lower dose caused you to stay up all night

[CobolCapsule]

If you end up not being ok wth the half dose maybe you could just tell the idiot what he wants to hear. Tell him the lower dose caused you to stay up all night

I did take half my dose last night and slept 2 1/2 hours. I called him today and spoke to him, and he told me it wasn't a sleeping pill. I said i know that!! Even though it is prescribed for sleep for some people, but i didn't want to argue with him.
He did tell me that i know myself better than he does, and i can either taper it slowly or stay at 1mg. He said i don't need his help with this, that i can handle this on my own, and make my own decisions.
My emotions are all over the place today with optimism and pessimism both.
I think i will go back to 1mg tonight, because i just don't feel right today. It would however be nice to have an opinion from a doctor, for mine offers me nothing.

[Shazerac]

Originally Posted by CobolCapsule

I did take half my dose last night and slept 2 1/2 hours. I called him today and spoke to him, and he told me it wasn't a sleeping pill. I said i know that!! Even though it is prescribed for sleep for some people, but i didn't want to argue with him.
He did tell me that i know myself better than he does, and i can either taper it slowly or stay at 1mg. He said i don't need his help with this, that i can handle this on my own, and make my own decisions.
My emotions are all over the place today with optimism and pessimism both.
I think i will go back to 1mg tonight, because i just don't feel right today. It would however be nice to have an opinion from a doctor, for mine offers me nothing.

Well there ya go, he said you could stay on the 1mg dose. And not to defend defend him, but you do know yourself better than he does. If you are comfortable with that dose then stay there.