Tag Archives: Risperdal

Deciding to Go on Psychiatric Medication #Write31Days

31 Days of Mental Health

Welcome to day 5 of the #Write31Days challenge. Today I’m focusing on a difficult decision people with mental illness might face: the decision to ask their doctors to prescribe them psychiatric medication.

Of course, patients do not make the decision to get on medication alone. Neither do doctors. Unless the patient’s mental illness causes them to be a threat to themselves or others, they cannot be forced to take medication. The patient decides whether they’ll swallow the pills prescribed to them, but the doctor ultimately decides what to prescribe. In other words, the decision about psychiatric medication is a cooperative process between doctor and patient.

Each time that I went on psychiatric medication, it was my doctor or another mental health professional who’d taken the initiative. Then again, being an informally-treated patient, I each time had the right to informed consent and chose to take my pills.

The first time I went on medication, in the summer of 2007, I was very seriously distressed. Looking back, the timing of my going on medication was about as wrong as can be. If I have to advise other patients on starting medication, I’ll advise them to change as little about the rest of their treatment or their lives as possible whilst trying the medication. I was pretty stupid in this respect, going on medication a week before I moved into independent living. Consequently, I didn’t have the opportunity to assess whether the medication worked. Maybe it did, but it is quite likely that, if it worked at all, it kept me just millimeters from falling off the edge of sanity.

I was also quite ill-informed about the medication’s side effects. The medication I was prescribed was Risperdal, an antipsychotic known for its metabolic side effects (ie. weight gain, risk of diabetes, etc.). Though I didn’t get any of these side effects as far as I knew, I did develop palpitations. The prescribing psychiatrist brushed this off, saying it was probably stress. Could be, but I’d never had this symptom before and never had it again. Since I know where to find reliable medication information, I quickly found out that heart palpitations are a relatively rare but very possible side effect from this medication.

Like the decision to go on medication, the decision to change a dose or to go off a medication again, requires cooperation between doctor and patient. Because I had moved a week after going on Risperdal and I didn’t have a psychiatrist in my new city, my GP was prescribing my medication. Understandably, she wasn’t sure how I’d do if she allowed me to quit the medication, so she was hesitant about this. I eventually just told her I was going to quit one way or another, and she recommended a taper schedule. In general, doctors have patients taper in relatively large steps, halving the dose one to several times and then stopping. It is however wise to taper more slowly.

I landed in a mental crisis four weeks after going off Risperdal. It is not known whether my going off of Risperdal caused me to fall off the edge, but I didn’t go back on medication right away. In fact, I didn’t go back for another more than two years.

I currently take Abilify, another antipsychotic, and Celexa, an antidepressant. People on antipsychotics are monitored for metabolic syndrome every six months to a year in my institution. When the monitoring project started, we were also given a long list of potential side effects and asked whether we had them or not. I had some, but not enough to warrant lowering my medication dose. The most common side effects of antipsychotics, other than metabolic syndrome, are movement disorders, like parkinsonism (stiffness and tremors similar to those in Parkinson’s Disease) and akathisia (severe restlessness and urge to move). There are medications that can counter thse side effects, particuarly parkinsonism. I don’t take any of these medications. However, it is very important to carefully consider the dosage of the antipsychotic and medications against its side effects. After all, most people want as few medications as possible, so it may not always be wise to counter each side effect with another medication.

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Psychiatric Medications for Autism #AtoZChallenge

Welcome to another day in the A to Z Challenge, in which I focus on autism. Today, I will discuss psychiatric medication as a treatment for autistic symptoms.

Many autistic children and adults take one or more psychiatric medications. Most of these are prescribed off-label, which means they have not been approved by the U.S. Food and Drug Administraiton (FDA) or similar agencies in other countries for the specific purpose of trating autistic symptoms, but the doctor feels they may benefit an autistic person anyway. In 2006, risperidone (Risperdal) got approved for the treatment of irritability in autistic children ages five to sixteen. In 2009, aripiprazole (Abilify) got approved for this purpose too. Both of these medications were originally developed for treating psychotic symptoms in people with schizophrenia, but they are commonly used for treating irritability in people with conditions like bipolar disorder too.

Antidepressants are also commonly prescribed to autistic children and adults because of their potental effectiveness in treating anxiety, depression and obsessive-compulsive symptoms, all of which are common in autistic people. Fluoxetine (Prozac) has been FDA-approved for treating both obsessive-compulsive disorder and depression in childern age seven and up. Citalopram (Celexa) was specifically studied for its effectiveness in treating repetitive behaviors in autistic children, but was not found to be very effective.

Since many autistic people have comorbid attntion deficit (hyperactivity) disorder, many also take stimulants like methylphenidate (Ritalin or Concerta). Some autistic people take anticonvulsants, usually for epilepsy, but these medications can also be used as mood stabilizers.

Many autistic people have strong opinions on medication. For example, many people feel that medications are too often used in a situation where there is limited support in order to drug someone into compliance. A few years ago, I read of a study on intellectually disabled people in institutions, which compared the classic antipsychotic Haldol to Ripserdal and placebo. Each, including placebo, was equally effective, presumably because the people in the study got quite a bit of attention from researchers and this decreased their aggression. I have mixed feelings about this. I may’ve written earlier that I was prescribed Risperdal a week before moving into independent living in 2007. In this situation, clearly the medication was used as a substitute for proper care. However, since going on Abilify (and Celexa) in 2010, I have also been feeling significantly better and more able to cope. When you get your child on medication, it is important to change the medication only and allow other circumstances to remain as much the same as possible. Otherwise, you won’t be able to test whether the medication works.

When I Shouldn’t Reach for My Meds (But I Do)

Today, I had a discussion with my psychiatrist. I’ve been feeling okay overall, but, when my therapist and social worker got talking to me about going into supported housing, it caused me to be irritable for days. I notice this a lot lately: when I’m able to stay in the present and just do my thing, I’ll still have some mood swings, but they aren’t nearly as severe as when I need to focus on the future. My therapist and I are clearly not on the same page in terms of my goals, and this causes me intense frustration. I’ve reached for my PRN medication almost everyday last week, even though it isn’t effective. At least the though that something would be numbing me and I had some control over my emotions was there.

My psychiatrist pretty much said that situational frustration is not a reason to reach for meds, and he’s right. That’s one of the main reasons I stopped my Risperdal, which had been used to make me just numb enough not to have a crisis while living independently, but not so numb that I didn’t feel the intense pain anymore. In a way, I want nothing to do with my increased dose of Abilify either. It wasn’t increased now, but it’s been increased twice since I came here seven months ago, while I’d been stable at a moderate dose for three years before I cam here. Medication isn’t a cure for shitty circumstances.

Yet I reach for medication everytime I feel frustrated. It’s probably what I’ve been learning to do. I can’t get more support if my therapist doesn’t want me to get it, and it’s still a fact that in psychiatric institutions, patients have little say in their treatment, unless their treatment goals are in line with the latest treatment philosophy. Back when patients had to be locked up for the rest of their lives, people wanting to move into the community, were medicated, secluded and otherwise forced into submission. Now that psychiatric services have to face budget cuts and their philosophy has changed to rehabilition, patients like me, who cannot cope with this pressure, are, albeit more subtly, still forced into submission. Still, the only way to numb the agitation that I feel at people trying to control my life, is to reach for my meds. It isn’t going to get me out of this vicious cycle, but then again, what is?

Antipsychotic Use in Autistics

Someone in a support group for pathological demand avoidance (a form of autism that is mostly only recognized in the UK) asked about using Risperdal (risperidone) for aggression and anxieyt. This prompted me to write about my experiences of medication use, and I want to elaborate on them, particularly as I made an interesitng self-observation today.

There is a lot of controvery surroudning the use of medications, particularly antipsychotics, for autism spectrum disorders. I personally do not disagree with the use of antipsychotics. They have a relatively solid evidence base, especially Risperdal and Abilify (aripiprazole). I have used both myself and currently take Abilify in a fairly high dose.

I have pointed this out before, but I want to say it again: if there are other changes in treatment, placement or support happening near the time you’re wanting to start medication, that’s not a wise moment to start medication. I started Risperdal a week before my move into independent living, and, if it had any effect at all, this was annihilated by the effects of the move. Also, don’t expect antipsychotics to get someone through a rough time These drugs are designed for long-term use and usually take several weeks to kick in. Benzodiazepines are better in this case, but don’t expect medications to cure support needs. Autistic people will always need support.

Antipsychotics are commonly used for aggression and irritability, but I made this interesting self-observation that my Abiilify also seems to help with rigidity and the resulting asocial behavior. I remember a few years ago reading a case study on the use of Abilify for core symptosm of Asperger’s (I’m too lazy to look up the reference). This may pose its own ethical dilemmas, cause what do we want to change about a utistics (especially children or others who are incapacitated) and what falls within the realm of acceptable neurodivergence? I wont’go into this right now.

To Medicate or Not to Medicate?

Yesterday, I was searching for autism bblogs and stumbled across Pam Byrne’s blog. In one of her latest posts, she writes about her son’s increasing and then decreasing behavior problems. One of the things that stuck out to me was the tough choice Pam made to medicate Alex.

Back when I first learned aobut autism, it was through Autistics.org and other autistic advocacy sites. I was a firm opponent of medicating for behavioral control, believing that an autistic child or adult should be helped with proper supports, not dulling meds. Particularly neuroleptics (antipsychotics) can cause severe cognitive dulling and other side effects with autistics, so I reasoned one should stay away from those especially.

That was in like 2006 to early 2007. In July of 2007, however, I was about to move to a new city and into independent living. I was having terrible meltdowns related to this. My community psychiatric nurse suggested a psychiatrist’s consulttion, and I agreed. The psychiatirst listened to my story and thought for a bit. Then she started to describe what she thought medication should do for me, and I paged my inner pharma encyclopedia to find out what she might be thinking of prescribing. She suggested Risperdal, an antypical antipsychotic. I had little opportunity to change my situation in any other way – the move, that was one of the worst moves in my life, had already been scheduled for the next week -, so I felt I had no other choice but to consent to the medication.

This was a bad choice: I had quite serious side effects that weren’t being taken seriously, and the med was used to dull me into submission when in fact living on my own was not suitable for me. I tapered myself off the Risperdal two months into my new living situation. Three weeks later, I landed in a psychiatric crisis tht led to hospitalization.

The psychiatrist who admitted me into the hospital recognized the need for better supports rather than medication. I agreed and was med-free apart from a PRN tranqilizer now and then for over two years.

However, supports have their limits. Especially in a society that relies on massive budget cuts, it’s not like you can actually get perfect supports. I at least can’t. Also, I have always wondered whether medication could somehow help me reduce the overlaod that is actually quite inherent in my experience of autism. Medication should not be used to manage behavior in an unsuitable situation, but what if one’s support situation is as suitable as can be? Could meds actually calm the autistic mind when it is nonsituationally unquiet?

I asked to be put back on meds in early 2010. The medication suggested by my psychiatrist this time was Abilify, another atypical antipsychotic. And to be quite honest, I like it. I started at a very lwo dose, which had to be increased three times. Not always did I agree to this, in the sense that on occasion I’ve felt that supports could’ve been improved, but they won’t whether I’m on meds or not. I have minimal side effects even on a pretty high dose of Abilify, and I can tell, three weeks after my l ast increase, that I’m happier this way. So is Pam’s Alex. Of course, with a child or non-communicative or intellectualy disabled adult, it’s harder to tell whether the person is truly happier than with a person like myself, who can communicate reasonably well. This is why I still advocate taking proper care when thinking of putting a child or communicatively impaired or intellectually disabled adult on an antipsychotic. These meds do dull cognition, and it can’t be known in these cases whether the person is truly less irritable. I strongly oppose the idea that this is not important, except when a person is severely aggressive or self-destructive. In cases other than this, a person should only be put on meds if they’ll actually be feeling better. I do, and going on Abilify was therefore one of the better decisions I’ve made in my life.