Risperidone high after increase in meds?

We’re new to Schizophrenia. Husband/wife team. I’m the researcher and “in charge” so to speak.

My trusting wife has left the meds in my hands. Meltdown started Christmas and ended up in hospital just after New Years. There they put wife on risperidone 1mg/day. I increased to 2 a week later. We also started in on Trazadone for sleep. And Mirtazapine. Soon I was able to stop the Trazadone as sleep went well. The other day we had a sleepless night preceded by 3 days of questionable thinking. (is this OK to be talking like this?) This so I administered Trazadone again and another risperidone, but no sleep led to voices and crying and carrying on. I called Nurse who prescribes locally and was told to increase to 4mgs Risperidone, 1 Trazadone. She slept next night find and things were looking up.

Well, we went to yard sales Sat… She was buying stuff and spending $$ that made no sense. I turned around and went back home. Next day she looked back and told me the voice in her head (her favorite sister) told her to buy the toy, a plastic cannon that makes a noise when a button is pressed, so the baby her cousin was to bear would be born without a hydrocephalic head. We had a chuckle over this next day, but I’m very concerned about the high she was experiencing the day after no sleep when her meds were increased. What was that about? I asked her if she was angry at me and taking it out on me which she denied. Where does the high come from, please.

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I have heard anecdotes of this initial response to Risperidone. Here is a study that might shed some light: Risperidone-induced mania: An emergent complication of treatment - PMC

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Hey, this is great!! Thanks so much for the study. By the way, I’ve been reviewing back issues of “Psychosis”, https://www.tandfonline.com/toc/rpsy20/1/2?nav=tocList. and I use scholar.google.com. Please, how did you manage to find this article?

I just googled schizophrenia and mania. Thanks for the link, I’ll check it out. Best of luck managing her symptoms. You are so fortunate that she is complying. That is often half the battle. Please continue to educate yourself and involve her to the greatest extent possible.

This is a disorder that has many faces and is among the most challenging mental illnesses but many people manage it with the right support and treatment.

Another tip: check out this Youtube channel, showing the lives of a couple also managing the illness as a team: https://www.youtube.com/@LivingWellwithSchizophrenia

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Thanks, we’ll both check it out. To be honest, I love research and reading about medical so this has really given me something to chew on. I didn’t recognize the response as manic till you pointed it out. Now I really understand what that term means. I’m afraid of the long term damage of the risperidone, but, for now don’t see much choice. I’m hoping to figure a way eventually to manage other ways. I see some countries try without meds, I think it was Norway. I saw that one state tries that too. Then I read about a “club” of people who refuse meds and try to manage the voices. The real challenge is the cultural difference. She’s from the Philippines so therapy, if we ever get to that will be a real challenge for the verbal barrier along with understanding small village/island culture. Wondering about finding a Visayan speaking therapist in the Philippines. I’ve read that Schiz. is the most common of the treated psych maladies there.

All anti-psychotic drugs carry risks, and most have side effects that may or may not be manageable. You trying to guess her dosage is not optimal and may make matters worse. Most people with this disorder have to try numerous combinations of medications to find the right mix, and this can take months or even years of trial and error. That is why it is so important to work with an experienced psychiatrist who is credentialed to dispense prescriptions and monitor her (often changing) symptoms side effects and overall situation. An additional therapist is also important, someone who can work with her to add on non-drug approaches, like talk therapy and cognitive behavioral therapy (CBT.) Perhaps at least temporarily, while you try to find someone who speaks her native language, you can take her back to the doctors at the hospital, or get a referral from them or her usual doctor?

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I remember when my husband (now ex) first started risperadone. He was whacky. Loopy. I think the med is strong, but it works for a lot of people. You may have to experiment w dosage.

I like that you chucked about the yard sale find. It’s always good to have a sense of humor. We used to laugh sometimes about the crazy ideas he had that we both thought were nutty.

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I think it’s also important to worry about the side effects of psychosis. I don’t have a link to the articles and research handy but each episode of psychosis is shown to cause damage to the brain. I’d rather my family member deal with the meds then that, but each to their own I suppose.

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My brother has been on that drug for years! He has the hand twitch but other than that, he his disease has been managed by taking the drug.

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Schizophrenia is on a spectrum that includes bipolar and schizoaffective disorder. If mood swings continue, she may need the addition of a mood stabilizer.

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Nice to know other people can also be entertained by this. Some might think this callous, but having a good attitude helps a lot otherwise we might be overwhelmed by all this, dare I say, lunacy?

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Your reply really gave me pause. I’ve been researching a bit. I did find this: Delayed Detection of Psychosis: Causes, Consequences, and Effect on Public Health | American Journal of Psychiatry
which makes me think that it’s only complete inattention to psychosis that is an issue of brain neurotoxicity. We attended to this issue right away and this was the first occurrence. I admit to skepticism of drugs and doctors, but not to inattention of my wife’s issues.

I didn’t mean to imply that you were inattentive. I was mostly speaking of my own family member, he was without correct medication for years and had many episodes of psychosis and hospitalizations with incorrect dx and treatment. Even after he was correctly diagnosed and treated he would forget to take his medication regularly and had more episodes of psychosis. We as his family can tell it has had an effect on his ability to think and problem solve. And I’ve read research about this effect and the suspected damage to the brain. I’m a physician who focuses more on natural remedies but my experience with Sz is that they need the medication to function properly in their own life and in the community. There’s been people who have told our family member that if he would just meditate that his disease would be cured. That frustrates me and scares me because those people haven’t had to support and help him and been through the hell we have. Our family member happens to be doing really well on medication and so for us it’s worth dealing with side effects as compared to the effects of no medication. And that’s just my opinion, and if someone figures out something different that works then I think that’s great for them.

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Thanks for the reply. We’ve yet to find a regular shrink nor therapist and so we’re off on our own. I’ve not cut back, quite the opposite, on her Risperidone (anti-psychotic) meds. Some of the issues she was evidencing during lock-up are no longer there, for example, hi-blood pressure.

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Yea, the hospitals definitely overmedicate, I agree with that. They put him on high bp meds as well and it was causing his bp to go very low. He hasn’t been on that for awhile. He’s on 3 meds now, but only because he needs them. The risperidone, gabapentin for anxiety because the hydroxyzine wasn’t helping at all, and trazodone because he gets insomnia so bad. It sucks to be on all those meds, and I know the side effect lists can be scary, but he’s doing so well with them that it seems worth it. Definitely better than the alternative of nothing, at least as far as his condition and severity level is concerned. Everyone is different.

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Your post was very timely. We had a bad night last night. No sleep at all and woke up with the voices again. Weekend, naturally, so no one to call. Last night we reached 6mg of Risperidine. Is that a lot? We started at 1Mg in hospital. I added 1Mg last night. I gave her a 2nd Trazadone which I’ve only done 1x before. She also took 1/2 Mirtrazapine (anti-depressant). Any suggestions. No sleep and talking bizarre stuff.

Just read on-line that maintenance dose: 2 to 8 mg orally per day
Maximum dose: 16 mg orally per day with increases at 1-2mg/day.
So we’re well within guidelines.

I don’t know for sure. My son was reduced to 4 and that’s when things went bad. He ended up on 8mg. Which upset all his doctors but the 4 wasn’t doing it. They just dropped him to 7 after 8 working really well, but his psychiatrist said 8 was really high. Based on my research I’m not sure, but we’ll see. He did have to increase trazodone to 100 bc he was struggling with sleep. Like I said, these high amounts aren’t great long term but his health and quality of life in the moment are the priority. He’s been doing really good with 100mg of trazodone for sleep. He’s taken to going to bed around 6-7pm and sleeping and alot, like to 6-7am. But it’s what’s working for him so there’s that. I’m sure it’s not an ideal life situation but him not being in psychosis or not sleeping for 3-4 days is what we want.

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Thanks so much for your reply. We’re still well within limits on Risperidone, but the info about Trazadone is well received. My initial understanding of the drug is that it’s an anti-anxiety at 150mg dosage or so, but more often used off-label as a sleep aid. We’ve only been using 50mg as a sleep aid when needed. Do you administer that needed or not for sleep? I’ve tried to increase that when my wife doesn’t sleep to 100Mg 2x, but she was so wired nothing seemed to help. I’m a senior and 7PM is my normal bedtime, then I read for an hour, but now with lack of sleep we’ve both been in bed by 7PM. I usually get up after 8 hours so 4AM is normal. I’ll wake my wife at 6AM to try to keep her on a schedule. I also try to keep her outside in the sun during the day to keep her internal clock set to daylight. We’ll finally meet with someone this week. I don’t have that much faith in the “professionals”. A night’s lack of sleep makes her loopy, talking trash and making no sense. The one good thing in all this is she trusts me, unlike the paranoia vented at most other people. Thanks for your open-ness, helps me a lot. There is another issue I have questions about. We were initially taking the anti-depressant Mirtrazapine, but although she was evidencing psychosis it was without depressive symptoms. I’m not so sure it’s depressive to be upset about this new diagnosis and looking forwards to the rest of her life on drugs nor is it so depressive to be upset about being locked up in hospital. Those issues are more real life threats that are depressing. So not sure if the anti-depressants are warranted and she really objects to them for the contraindications. I wish there were a better sleeping type pill when she starts obsessing over some bizarre thinking.

My son had been taking the trazodone nightly now for 7 months no matter what. I’m sure everyone is different but he was struggling so much with sleep and it would get out of control with 3-4 days with no sleep despite trying. Then he couldn’t work, psychosis, severe substance use to try and medicate, it was awful. He was on 50 mg and they finally upped it to 100. I know they were hoping to stay with 50 but it just wasn’t working. I think we had the same experience , that just using the trazodone as needed wasn’t working for him. That’s why we went up and he takes it nightly. He hasn’t had more then a few hours of insomnia since he started using it like that.

He slept ALOT after his last bad episode last summer. He usually goes to bed a bit after 6pm so I have to do his med check with him at 6 because he would be sleeping if I waited until later and I’d have to wake him up. He does occasionally work until 9:30 but I think he naps on those days to compensate. I don’t live with him but he tells me he’s up around 6am every day.

He is not on depression meds. I don’t recall if he ever was but it’s been 4 years of many, many hospitalizations, but I don’t think so. He does definitely experience depression at times. His primary talked to him about it and said its normal to feel some depression around his diagnosis and probably needing meds for the rest of his life. He’s only 22. I can tell he gets a bit depressed when he’s let go from a job and not working.

We are fighting for SSI/SSDI assistance right now. He worked full time for years and it seemed to be part of the issue with him not being able to be mentally stable. They say he’s not sick enough to qualify.

He does work a small amount but he’s so much better when he has work. Mentally he’s in a much better place, I can tell he’s happy. His condition has lost him most of his friends and family support so he doesn’t have much interactions besides me. That’s why PT job is so helpful for his depression.

If it were me I’d bring that piece up with the prescriber. I hate how I’m perceived but I have learned I have to absolutely be an advocate for him. The new psychiatrist has made these little snotty jokes about my helping and supporting him, really makes me angry because this guy sees my son for like 5-10 min every couple of months. He has no idea how many times the last 4 years we tried letting our son figure this out on his own. I’ve been very involved and supportive for the past 7-8 months now and guess how many times he’s decompensated since then? None, compared to every couple of months before that.

I don’t have much faith in most of the professionals either but we need them so I try to get him the best. I don’t care for this particular psychiatrist and I’ve talked with my son but he said he’s okay with him and he doesn’t always feel that way so I let it go. His primary care provider is awesome and super supportive of him getting help from his family.

It’s great that you are so willing to be this involved and supportive. Just remember to do something you enjoy. I found it very easy to be stressed about all this every waking minute and it was exhausting and depressing for me. I don’t know if he’ll ever not need daily support. That’s a bit depressing but we are finding a good balance. We decided it’s better then seeing him doing so bad and needing hospitalized every few months. That was stressful and depressing as well, so this current situation is much better.

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