Risperidone depression from

Janicak et al. (87) studied the relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder. Sixty-two patients (29 depressed type, 33 bipolar type) entered a randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). They found no difference between risperidone and haloperidol in the amelioration of psychotic and manic symptoms nor any significant worsening of mania with either agent. For the total PANSS, risperidone produced a mean decrease of 16 points from baseline, compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively and for the CARS-M mania factor, 3 and 7 points, respectively. 

Additionally, risperidone produced a mean decrease of 13 points from the baseline 24-item HAM-D compared with an 8-point decrease with haloperidol. In those patients who had more severe depressive symptoms (HAM-D baseline score 20), risperidone produced at least a 50% mean improvement in 12 of 16 (75%) patients, in comparison with 8 of 21 (38%) patients receiving haloperidol. Haloperidol produced significantly more EPS and resulted in more dropouts due to any side effect. 

In an open study of 11 patients with typical borderline personality, Schulz et al. ( 253) found substantial improvement with olanzapine, particularly in psychosis, but also in anergia, hostility, and interpersonal sensitivity. Szigethy and Schulz ( 254) reported improvement in one patient whose BPRS went from 46 to 28 with risperidone. Remission of self-mutilation has also been reported in one borderline patient undergoing treatment with risperidone, as well as an SSRI, for depression (255). This patient was then able to return to a full-time job. Although one should reserve judgment until more definitive studies are completed, the more favorable side effect profile of risperidone and olanzapine suggests that these drugs may be useful when psychotic or near psychotic symptoms are present. 

A pharmacokinetic interaction of risperidone with fluoxetine has been reported (SEDA-22, 71). When 10 schizophrenic patients stabilized on risperidone 4-6 mg/ day took fluoxetine 20 mg/day for concomitant depression the mean plasma risperidone concentration increased from 12 to 56 ng/ml at week 4 the concentration of 9-hydroxyrisperidone was not significantly affected (51). One patient dropped out after 1 week because of akathi-sia associated with a markedly increased plasma risperidone concentration. 

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