Depression risperidone

Conventional antipsychotic drugs such as chlorpromazine and haloperidol have long been used in the treatment of acute mania. More recently, atypical antipsychotic drugs including aripiprazole, olanzapine, quetiapine, risperidone, and ziprasi-done have been approved for the treatment of bipolar mania or mixed mood episodes as monotherapy or in combination with mood-stabilizing drugs.25 Aripiprazole and olanzapine are also approved for maintenance therapy. The combination of olanzapine and fluoxetine is approved for treatment of bipolar depression. Quetiapine is approved for treatment of... 

Lithium, divalproex sodium (valproate), aripiprazole, olanzapine, que-tiapine, risperidone, and ziprasidone are currently approved by the FDA for treatment of acute mania in bipolar disorder. Lithium, olanzapine, and lamotrigine are approved for maintenance treatment of bipolar disorder. Quetiapine is the only antipsychotic that is FDA approved for bipolar depression. 

Alternatively, the current antidepressant may be augmented (potentiated) by the addition of another agent (e.g., lithium, T3), or an atypical antipsychotic (e.g., risperidone). Risperidone has been shown to be effective in combination with fluvoxamine, paroxetine, or citalopram in treatment-resistant depression. Olanzapine and fluoxetine have been found to be safe and effective in treatment-resistant depression. 

Among these choices, bnspirone is preferred if the patient is also experiencing anxiety. If the patient is depressed and agitated, a SSRI should be tried first. Second line choices inclnde carbamazepine (Tegretol) or one of the atypical antipsychot-ics—ziprasidone (Geodon), risperidone (Risperdal), olanzapine (Zyprexa), quetiap-ine (Seroquel), or aripiprazole (Abilify) can be tried. If psychotic symptoms are present, one of the atypical antipsychotics should be tried first. 

Topiramate may affect alcohol, amitriptyline, CNS depressants, lithium, oral contraceptives, digoxin, estrogens, hydantoins, metformin, risperidone, and valproic acid. 

HT2 antagonists like trazodone, nefazodone, clozapine and risperidone are used in the treatment of schizophrenia and depression. They block adrenoceptors and Hi-histamine-receptors as well. Hypotension, drowsiness and weight gain can occur. 

Chart reviews and open trials of outpatients with bipolar disorder and bipolar spectrum disorder have been published for 28 risperidone- and 23 olanzapine-treated treated children and adolescents (Frazier et ah, 1999 2001). Significant decreases in mania, depression, and aggression ratings occurred over the course of treatment however, other medications were also used simultaneously. Additional anecdotal information exists for olanzapine (Soutullo et ah, 1999 Chang and Ketter, 2000), quetiapine (Schaller and Behar, 1999), and clozapine (Fuchs, 1994). 

Risperidone > placebo for repetitive phenomena, aggression, anxiety, depression, irritability, and autistic symptoms... 

Mood Disorders. Risperidone has also been reported to benefit major depressive disorder with psychosis, bipolar mania, and schizoaffective disorder ( 83, 84, 85, 86 and 87). 

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. 

Combined risperidone and electroconvulsive therapy (ECT) produced a remarkable improvement in one patient s refractory depression, but it also caused a return of prior TD symptoms (106). When clozapine was added to the ECT-risperidone regimen and risperidone was tapered gradually, the patient s TD signs and symptoms remitted, and she responded well to combined ECT and clozapine. 

Conley et al. (121) reported a large, double-blind study comparing risperidone with olanzapine. This study included about 400 patients randomly assigned to a flexible dose of risperidone (2 to 6 mg) or olanzapine (5 to 20 mg) for 8 weeks. On many measures, clinical improvement was the same however, risperidone did produce a slightly greater improvement than olanzapine on positive symptoms and on the anxiety/depression subscale. Most patients on risperidone received 4 to 6 mg/day, whereas half the patients on olanzapine received 10 mg and 10% received 5 mg. The mean dose of risperidone was 4.8 mg/day and for olanzapine 14.3 mg/day. 

Risperidone Acute Clinical Trials. Hillert et al. (107) found risperidone to have both antipsychotic and antidepressive properties in 10 patients with schizoaffective disorder, depressed type. These investigators prescribed 2 to 10 mg/day for 6 weeks in an open-label pilot study, and found marked improvement in psychosis in all patients and clinically significant overall improvement in psychosis in 7 to 10 patients. Two patients required antiparkinsonian drugs otherwise risperidone was well tolerated by the group. 

Dwight et al. (291) reported their experience with risperidone in eight patients with schizoaffective disorder (six bipolar type two depressive type). All six bipolar type patients showed the onset of or an increase in mania shortly after starting risperidone (mean number of treatment days = 7 3 mean dose = 7 1 mg/day). In this context, O Croinin et al. (292) reported on a chronic paranoid schizophrenic patient who was admitted in an acute psychotic state unresponsive to thioridazine or CPZ. Risperidone was started (6mg/day by day 3), but by the end of the first week she was displaying hypomanic symptoms. When risperidone was discontinued and haloperidol introduced, her hypomanic symptoms resolved. 

Goodnick (293) reported on two acutely bipolar manic patients who had not responded to or could not tolerate lithium but did respond favorably to risperidone. The author also hypothesized that risperidone s ability to block 5-HT 2 receptors may make this agent useful for treating both mania and psychotic depression. 

Janicak et al. (113, 283) recently reported the results of a double-blind, randomized trial of risperidone monotherapy versus haloperidol monotherapy for controlling both psychotic and mood symptoms in 62 patients with schizoaffective disorder (bipolar or depressed subtype). These authors observed that, in comparison with haloperidol, risperidone was as follows ... 

Hillert A, Maier W, Wetzel H, et al. Risperidone in the treatment of disorders with a combined psychotic and depressive syndrome—a functional approach. Pharmacopsychiatry 1992 25 213-217. 

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. 

Lane HY, Chiu WC, Chang WH. Risperidone monotherapy for mania and depression. Am J Psychiatry 1999 156 1115. 

Another group of mood-stabilizing drugs that are also anticonvulsant agents have become more widely used than lithium. These include carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence. Lamotrigine is approved for prevention of recurrence. Gabapentin, oxcarbazepine, and topiramate are sometimes used to treat bipolar disorder but are not approved by FDA for this indication. Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone are approved by FDA for the treatment of manic phase of bipolar disorder. Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression. 

Aripiprazole Blockade of 5HT2A receptors > blockade of D2 receptors Some a blockade (clozapine, risperidone, ziprasidone) and M-receptor blockade (clozapine, olanzapine) variable receptor blockade (all) Schizophrenia—improve both positive and negative symptoms bipolar disorder (olanzapine or risperidone adjunctive with lithium) agitation in Alzheimer s and Parkinson s (low doses) major depression (aripiprazole) Toxicity Agranulocytosis (clozapine), diabetes (clozapine, olanzapine), hypercholesterolemia (clozapine, olanzapine), hyperprolactinemia (risperidone), QT prolongation (ziprasidone), weight gain (clozapine, olanzapine)... 

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