Oksnoh: Introduction - Tapering off of Latuda (Tachyphylaxis) Need Guidance

[Oksnoh]

Hi, 

 

I was on antipsychotics for about 6 months, for a brief drug-induced psychosis that I had (lasted a very long time). I'm running into various issues during my taper and I am looking for immediate guidance. Hopefully someone can relate or have had similar stories, and can help. 

 

So for starters, I was on haldol/zyprexa for a few months, switched to risperidone, abilify, then finally Latuda.. Unfortunately, Latuda had suddenly stopped working for me (tachyphylaxis, I think), so what immediately ensued were several panic attacks, horrible anxiety, and eventually tardive psychosis (which in my opinion, was rebound psychosis that had evolved into post-withdrawal discontinuation psychosis).

 

I tried to reinstate Risperidone at 0.5 mg to soften the blow of my withdrawal-psychotic symptoms and anxiety, however, I am beginning to think that it is making matters much worse. As I may be getting an adverse reaction to the Risperidone at 0.5 mgs. Unsure what to do now, if I reinstate an antipsychotic at a much higher dose to treat the withdrawal-psychosis, I could run into tachyphylaxis again, correct?

 

Any advice would be extremely helpful, these weeks, months, have been incredibly hard and taxing on my mental and physical health. 

 

Best,

Oksnoh

Edited October 17, 2021 by Oksnoh
Introduction Tag

[Oksnoh]

Oksnoh

 

Hello people,

 

I first had a psychotic break in December, that lasted a few months. What built up to the full-blown psychosis was a gradual, worsening of a manic episode that ran it's course over the period of 3 years.

Since December, or, my full-blown psychosis I've been on various antipsychotics to bring me out of my psychosis. I was on Zyprexa at first, then Haldol, then Risperidone, then Abilify, then Latuda (experienced rapid tachyphylaxis), then 

finally, Risperidone.

 

January and February, I was on 15 mgs of Haldol.

Dropped down to 5 mgs of Haldol in and around March.

Moved to 2 mg of Risperidone around March and April.

Switched to 20 mg of Latuda in June, however, Latuda suddenly stopped working (panic attacks ensued, daily for several hours at a time. Had severe nervous system reactions, Dystonia as well. Developed Withdrawal Induced TD). 

On 0.5 mg of Risperidone currently, which does NOT feel like enough, my body is screaming for a higher dosage of antipsychotics, however, to my knowledge, upping the dosage during poop-out is supposed to make things worse.

Trying to hold 0.5 mg of Risperidone as long as possible, currently, October 19th. 

 

Symptoms- 

Disorganized thoughts (new withdrawal symptom, introduced at the same time of the withdrawal induced paranoia).

Paranoia (does not feel like organic psychosis, or my original psychosis at all).

Brain tension (strange feeling in my brain at various times throughout the day).

Crying spells (frequent mood swings, not a huge issue). 

 

Edited October 19, 2021 by ChessieCat
added topic title before merging with intro topic

[Altostrata]

Welcome, @Oksnoh

 

On 10/17/2021 at 5:54 AM, Oksnoh said:

So for starters, I was on haldol/zyprexa for a few months, switched to risperidone, abilify, then finally Latuda.. Unfortunately, Latuda had suddenly stopped working for me (tachyphylaxis, I think), so what immediately ensued were several panic attacks, horrible anxiety, and eventually tardive psychosis (which in my opinion, was rebound psychosis that had evolved into post-withdrawal discontinuation psychosis).

 

This suggests to me that you got withdrawal or other adverse effects from the earlier drug switches, rather than Latuda stopped working.

 

Did Latuda ever "work"? What period was that, and what did it feel like? Did you ever skip a dose, or take it off-schedule?

 

What times o'clock do you take all of your drugs, with their dosages?

 

On 10/17/2021 at 5:54 AM, Oksnoh said:

so what immediately ensued were several panic attacks, horrible anxiety, and eventually tardive psychosis (which in my opinion, was rebound psychosis that had evolved into post-withdrawal discontinuation psychosis).

 

Did this occur in June? When did you start 0.5mg risperidone again? How did it affect these symptoms?

 

On 10/19/2021 at 9:30 AM, Oksnoh said:

Disorganized thoughts (new withdrawal symptom, introduced at the same time of the withdrawal induced paranoia).

Paranoia (does not feel like organic psychosis, or my original psychosis at all).

Brain tension (strange feeling in my brain at various times throughout the day).

Crying spells (frequent mood swings, not a huge issue). 

 

Could you explain more what each of these symptoms feel like, in your own words?

 

Thanks for your drug history. When you get a chance, please follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[Oksnoh]

I have a strong hunch that the Latuda was the culprit for the brunt of my withdrawals. Latuda worked great for the first few months I was on it, almost too well.

I had 0 side effects, except for maybe low energy on the short amount of time I was on it, which was roughly 1 month, possibly a little over a month. The panic attacks occurred sometime in June, yes. 

 

I started the 0.5 mg of Risperidone when the withdrawals and tardive psychosis became too difficult to bear, it was pure agony. This was sometime around August. I spoke to another person who dealt with tachyphylaxis and subsequent withdrawal induced psychosis from Latuda, who gave me a very similar account of experiences to mine. I am just hoping that these symptoms subside and that I don't actually see my original psychosis returning. 

 

The psychosis I'm experiencing, at least, the more notable symptoms are disorganized thoughts and a physical feeling of "being watched". I feel like I'm being watched but I'm completely aware no one is watching me. This feels markedly different from my original psychosis where I lacked the awareness to even judge whether my experience was real/or internal (not real). Additionally, the main difference from my original psychosis to the psychotic symptoms I'm experiencing now, is that the psychotic symptoms I'm experiencing are agonizing. Mostly because I'm painfully aware of my own symptoms.

 

I reinstated at 1.0 mg Risperidone for a few days to reevaluate my symptoms, what happened was an immediate and complete reversal of my psychotic symptoms, which from my research, is another indication of my symptoms being withdrawal-induced as opposed to organic (I did not stay at 1.0 mg in fear of a 2nd tachyphylaxis). 

 

The first few months of panic attacks and anxiety were accompanied by pacing, non-stop pacing around my home street and block (around my neighborhood). I paced for several hours of the day; 4-5 hours, minimum. After the panic attacks had stopped and my nervous system had somewhat calmed down, immediate psychotic symptoms ensued. Which were disorganized thoughts and the "feeling of being watched", I had described earlier. I'm now at the point where I'm mostly just bedridden because of these symptoms. My nervous system still feels very much so impacted; I have weird strains and tension in my head and I can feel that my nervous system feels very much so, fried.. For a lack of better words. 

 

The windows of relief are a new/more recent appearance for me.

 

Additionally, I am experiencing waves and windows of symptoms. Although my psychotic symptoms are persistent throughout much of my day, if not all of my day.. I get waves where my psychotic symptoms are the least tolerable, and windows of relief where my psychotic symptoms are far more manageable and tolerable (I can almost function while still experiencing them). 

 

Recently my symptoms have been becoming a little more predictable, where I feel like my day consists of "waves" and "windows", however, my psychotic symptoms are very persistent and extremely annoying and uncomfortable, to say the least. However, I often wonder whether how long this stage will last and if I will ever recover from this phase that I'm in. 

[Altostrata]

1 minute ago, Oksnoh said:

The panic attacks occurred sometime in June, yes.

 

On 10/19/2021 at 9:30 AM, Oksnoh said:

Switched to 20 mg of Latuda in June, however, Latuda suddenly stopped working (panic attacks ensued, daily for several hours at a time. Had severe nervous system reactions, Dystonia as well. Developed Withdrawal Induced TD). 

 

But you had also switched to Latuda in June. If you switched to Latuda and then got panic attacks, etc., when did you have your honeymoon period with Latuda?

 

It was only August that you started taking 0.5mg risperidone. At most, you were taking Latuda perhaps 10 weeks. 

 

Quote

(panic attacks ensued, daily for several hours at a time. Had severe nervous system reactions, Dystonia as well. Developed Withdrawal Induced TD).

 

Can you give approximate dates for when you had these symptoms? I am trying to figure out where they might have come from.

[Oksnoh]

Forgive me, my recollection of the timeline of when I took Latuda may not be completely accurate. But it must have been late May, possibly mid may, I took Latuda until sometime in July. July is where the panic attacks immediately surfaced. My honeymoon period must have been in June. I'm now realizing what you're saying, the withdrawal symptoms could definitely have been from the earlier antipsychotics, now that I think about it.

 

As for an approximate date for when I started to have the panic attacks, it must have been early-mid July; I texted a family member that I was getting panic attacks then, and was considering re-hospitalization in order to get relief for them. The onset of my psychotic symptoms was around August 25th, I tried to record the first date of the onset of my psychotic symptoms. 

 

From my recollection, Latuda had pulled me out of my lingering delusions from my original psychosis, so at the short duration I took it, it did work extremely well. However, I did extremely suddenly get horrible, horrible panic attacks and anxiety near the end of when I took it. 

[Oksnoh]

I still have withdrawal induced tardive dyskinesia, this appeared almost at the same time I started to get panic attacks and severe nervous system reactions from the Latuda. I have uncomfortable facial tics and facial grimacing, which seems to get worse during stress. 

[Altostrata]

5 minutes ago, Oksnoh said:

However, I did extremely suddenly get horrible, horrible panic attacks and anxiety near the end of when I took it. 

 

Did your Latuda dosage change over the time you took it? Were any other drugs added or taken away?

[Oksnoh]

My latuda dosage changed once, I was at 20 mg for the first few weeks, and my doctor had tried to change it to 40 mg (for 0 reason and I had no explanation as to why she tried this). No drugs were added. However, I was on much higher dosages (in terms of anti-psychotic dosage equivalences) earlier on in my treatment (before Latuda). 

 

I was on 15 mg of haldol for a few months, then 5 mg of haldol for few months, 5 mg of abilify at one point (only 10 days), 2 mg of risperidone (a few weeks, if that). 

[Oksnoh]

I investigated reddit to see if additional people had similar accounts as me. This person has an extremely similar withdrawal experience to mine, they are nearly identical. 

 

 

I had zero issues with mood until the Latuda had stopped working suddenly. My mood became far more chaotic, as it did with this person. 

I'm not sure if this is at all related, probably not, but the individual in this post makes remarks about having "jumbled thoughts", and the feeling of being watched, both of which I developed after withdrawing from Latuda.

They could be organic symptoms, but they also could be withdrawal considering that the windows of relief that I get give me lots of relief to these symptoms.

[Oksnoh]

Update: System is telling me to updose, updose, updose... However I'm afraid to updose as I have already reached Tachyphylaxis once. I don't want it happening again. 

 

I suppose the good thing is, my system wants an updose, which means I'm still in the acute phase of withdrawal. The bad thing is, I don't know how long this stage will last, or if holding will provide me any relief. I'm not sure what to do at this point, updosing may provide temporary relief, but I'll be at risk for tachyphylaxis. Reducing/tapering may potentionally worsen my psychotic symptoms, or it might make the withdrawals easier? 

 

Body is telling me updose; brain doesn't want tachyphylaxis. 

 

Hope someone more knowledgeable can help. I don't know what it's like for antidepressants, but does anyone know if reducing/tapering made your depression worse? Perhaps I can use an analogous situation so that I can have a better idea of how to alleviate my psychotic symptoms without putting me at further risk.  

 

I seem to be at a constant dilemma, to hold, or to reduce? This is so awful, waiting on my next window. 

[Oksnoh]

9:00 PM EST, wave has subsided, longest wave yet this week I feel like. In a window, still dealing with psychotic symptoms. Not sure if my waves are being longer but it sure feels like it, :(. Hopefully this window lasts for a somewhat decent time. Will record once again tomorrow morning.

[Oksnoh]

7:00 AM, woke up in a wave, or at least it seems like a wave. Dealing with psychotic symptoms, just waiting to see how long this'll be. It definitely does feel like my waves are becoming longer and longer, we'll see. 

[Oksnoh]

12:43 PM, still in a wave, seems like it gets worse throughout the day. Bedridden, can’t move, hopefully I get the next window soon. 🤞, this is so tough. 

[Oksnoh]

2:00 PM - 4:00 PM, hit somewhat of a window, persistent psychotic symptoms, but when I hit the windows they're more tolerable. It feels like my brains trying to get rid of the sensations/psychotic symptoms. We'll see. 

[Oksnoh]

5:00 PM, feels like a wave is coming on again. Trying to document how long each window and wave lasts. Hopefully my windows get larger! Waves are lasting a long, long time. :/. 

[Greatful]

@Oksnoh  Hi I wanted to welcome you to SA.  I can not advice you on what to do with up dosing, mods are much more knowledgeable than me. I wish I would have gotten my advice from SA not my doctor all last winter.......

 

I wanted to point you in direction of the Symptoms & Self-Care forum.  I found so much relief reading that other people where experiencing similar crazy things like me.  I to had un explained fear.  I would look around a try and find what I should be afraid of.  

I had a very rough year.  I tapered off Prozac to quick went into WD Doc and I didn't know that it was WD, started the try this try that drug form dec to april.  I was on Seroquel for about 6 weeks and had side affects CT'd Not sure what  caused what but I thought I was going crazy.  I started and stopped several drugs that winter. I started think the birds might start talking to me,  and the wind outside might turn into a mans voice and talk to me, other scary thoughts running through my mind and the unexplained fear.    I got advice from SA in May and  was told to not make more changes and hold to stabilize.  Most of the crazy things have diminish, I don't worry about the birds, or the wind. HA,HA

Just know these drugs are very powerful.😖

 

I have depression,  anxiety, panic, OCD, rumination, obsessing, numbing on the face, weakness in the arms and legs, dizziness, brain buzzing, burning, crushing feeling, brain disconnection just to name a few.  You will find these and many others on the Symptoms & Self-Care forum

 

You asked about depression and yes it can be very  common in WD

 

Hang in there, you will be okay.❤️

 

 

 

[Oksnoh]

Hey @Greatful, thank you so much for responding. Fear seems to be a withdrawal effect from using Anti-cholinergic medications, I'm feeling fear strongly as well; I'm afraid to go outside, afraid to go into certain rooms of my house, all very bizzare and not symptoms of my original diagnosis at all. I'm sorry you had a rough year, 😕. That's good most of the psychotic symptoms disappeared for you, I'm still very much in the thick of things. 

 

Thank you so much for the reply, it means a lot to me. 

 

Warm regards, 

Oksnoh.

[ChessieCat]

On 10/22/2021 at 10:40 AM, Altostrata said:

please follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

 

Please create your drug signature as soon as you can.  I means that the staff can see your drug history at a glance and they do not need to read by through your posts to get the information, so it saves time.  Thank you.

[Oksnoh]

October 23, 2021- 7:58 PM, experiencing some DP/DR, still persistent paranoia. Withdrawal-emergent TD seems to be getting worse. The facial tic that was originally affecting my forehead has expanded to my cheeks. Odd because I was expecting the WE-TD to stabilize, instead it's getting worse. :(. Experiencing some mild depression, waves are long, windows are kind of stabilizing, as in, they aren't as good but they seem to be for a longer period of time with me being able to tolerate the psychotic symptoms better. Still feeling very stressed from daily tasks (using the bathroom, getting out of bed, going out for groceries, etc). Additionally, getting headaches and weird, brain tensions throughout the day. 

 

The stress hadn't been an experience during my anti-psychotic use, so I'm assuming it is a withdrawal symptom. 

[Altostrata]

On 10/19/2021 at 9:30 AM, Oksnoh said:

Latuda suddenly stopped working (panic attacks ensued, daily for several hours at a time. Had severe nervous system reactions, Dystonia as well. Developed Withdrawal Induced TD). 

 

Did this happen after the Latuda dosage increase to 40mg?

 

If so, the Latuda did not stop working suddenly. Those are symptoms of TOO MUCH Latuda.

 

You've been on and off a number of antipsychotics. all of which can cause such adverse effects as paradoxical activation (anxiety, panic attacks; at the extreme, akathisia), dystonia, and movement disorders. After a while, your nervous system becomes less able to resist these adverse effects. When Latuda was increased to 40mg, they broke out.

 

This is not tachyphylaxis. I believe you have been misintepreting your symptoms.

 

When did tardive dyskinesia start?

 

On 10/21/2021 at 4:54 PM, Oksnoh said:

I reinstated at 1.0 mg Risperidone for a few days to reevaluate my symptoms, what happened was an immediate and complete reversal of my psychotic symptoms

 

When did this happen? If this amount of risperidone resolved your symptoms, why did you not continue to take it.

[Oksnoh]

It happened after, I believe. I took the 20 mg, it was working fine until my doctor decided she wanted to reach the minimum effective dosage, which is 40 mg. It's possible, but I feel like my symptoms are more consistent with withdrawal as opposed to a side effect or an adverse effect of an antipsychotic. Adverse side effects I've experienced are at most, things like akathisia, anger, pacing, or emotional blunting. I've never had a panic attack resulting from too high of an antipsychotic dose.

 

Additionally, I experience/still experience extreme fear.. that is a symptom of anti-cholinergic withdrawal. I had temporal lobe seizures (from abrupt cessation) as well; I'm fairly certain this was the result of a lack of medication in terms of dosing (hence, I was leaning towards tachyphylaxis). 

 

The tardive dyskinesia happened during the same time the panic attacks manifested; withdrawal-emergent TD is also a symptom of super-sensitivity psychosis. Had I had movement disorders/tics resulting from the Latuda dosage itself, I would have agreed with your statement. However, I experienced the tardive-dyskinesia at or around the same time the severe anxiety and panic attacks emerged. Please see table 3 and 4, https://www.karger.com/Article/FullText/477313 .

[Oksnoh]

Again, I am reluctant about taking the Risperidone at 1.0 mg because once tachyphylaxis happens, it can happen again. I wanted to avoid up-dosing to avoid any adverse side effects of up-dosing during tachyphylaxis. The 1.0 mg of Risperidone did in fact resolve all of my psychotic symptoms, however, I experienced extreme anger and some weird, cognitive issues. 

 

There are several times throughout my day I want to just say, eff-it, I can't handle the agony of my psychotic symptoms, I'm up-dosing.. In order to relieve myself of the psychotic symptoms.. This was not like my original psychosis, at all. Please see table 3, where they highlight the "Psychological belief of the need for the drug",  as a symptom of rebound psychosis. Additionally, my psychotic symptoms were immediately resolved by a higher dosage of medication, please see table 3 where the "Rapid improvement after reintroduction of the drug", is listed.. This was also unlike my original psychosis, where it took several different drugs and medications in order to effectively bring me down from my delusional/psychotic state.. 

 

My symptoms are consistent with several of the criteria for rebound and super-sensitivity psychosis (rebound psychosis becomes super-sensitivity psychosis after it becomes persistent, meaning, lasting for more than 3 months). 

 

 

[Oksnoh]

If in fact I am experiencing tachyphylaxis and as a result, super-sensitivity psychosis. My question is, is it possible for me to up-dose again and start tapering from that dosage while avoiding the mess of symptoms associated with poop-out? 

[Oksnoh]

Additionally, I don't think I took antipsychotics long enough for tardive-dyskinesia... It started at the same time I think my Latuda stopped working. It makes more sense that the TD I'm experiencing is the WE-TD subtype. I know I've already said this, but there is a correlation between WE-TD and super-sensitivity psychosis.. And it makes sense I was experiencing the panic attacks, anti-cholinergic withdrawal symptoms like extreme fear, as a result of my nervous system reacting to the absence of the medication (or at least, a therapeutic dosage which is now higher because I've already reached tachyphylaxis once). 

[Oksnoh]

6:00 PM: Window of relief. disorganized thoughts are worst in the mornings. Much better currently, paranoia is still persistent.

[Altostrata]

Some of your symptoms are withdrawal-related. But I believe your interpretation of your tachyphylaxis is incorrect. It looks fairly clear that the symptoms you believe indicate tachyphylaxis were adverse effects of the drug, probably due to Latuda dosage increase, NOT the drug suddenly failing to work.

 

4 hours ago, Oksnoh said:

Again, I am reluctant about taking the Risperidone at 1.0 mg because once tachyphylaxis happens, it can happen again. I wanted to avoid up-dosing to avoid any adverse side effects of up-dosing during tachyphylaxis. The 1.0 mg of Risperidone did in fact resolve all of my psychotic symptoms, however, I experienced extreme anger and some weird, cognitive issues. 

 

Your current symptom pattern appears to be withdrawal symptoms from going off Latuda. As you've found, taking 1.0mg risperidone almost eliminates these withdrawal symptoms. It is typical of withdrawal syndromes that reinstatement of the drug or a similar drug resolves the symptoms.

 

Since you're wrong about earlier tachyphylaxis, your assumption you must avoid tachyphylaxis by not updosing doesn't make any sense. You have not yet experienced tachyphylaxis from anything, but you will have withdrawal symptoms in the meantime.

 

What I would be worried about in connection with updosing risperidone, is not tachyphylaxis -- there's no way to tell when this would happen -- but that continuing any antipsychotic will make you more prone to TD. The genie is out of the box. From this time forward, I would want to take the absolutely lowest effective dosage of an antipsychotic, if you absolutely need an antipsychotic.

 

We don't have any magic formulas for resolving withdrawal syndrome. You have the solution in your hand -- reinstating a bit more risperidone. It's clear that 0.50mg isn't enough; even 0.75mg might be better. 

 

If you don't care to do this, you'll have to cope with withdrawal symptoms until they go away. You can do this, it's your choice.

 

Here is a list that includes non-drug techniques to cope with withdrawal symptoms.

 

4 hours ago, Oksnoh said:

Additionally, I don't think I took antipsychotics long enough for tardive-dyskinesia... It started at the same time I think my Latuda stopped working.

 

This is another incorrect assumption. You have been taking tardive dyskinesia-inducing drugs since January 2021, nearly 10 months, with apparent excessive dosing of Latuda that initiated TD and other adverse drug reaction symptoms.

 

In sum, you probably are experiencing withdrawal syndrome from Latuda along with residual adverse effects, including TD, some possibly related to supersensitivity psychosis (a withdrawal symptom).

 

You can reinstate a bit more risperidone, or you can cope with your symptoms until they go away. I would be concerned that your symptoms might land you back in the hospital, for more substantial re-medication, but you would rather not increase risperidone. I don't think there's anything left for us to discuss. The choice is yours.

[Oksnoh]

I will not discount your assertion that my symptoms are not the result of tachyphylaxis, however, if they are in fact the result of tachyphylaxis, would up-dosing give me trouble? I've heard from some that it was met with adverse effects, and some saying that it worked for a little bit, but eventually the slight up-dose caused more harm than good. 

 

I'm presenting this hypothetical scenario because I'm fairly certain what I'm experiencing is tolerance, can you provide me any information on what up-dosing could do if that were the case?

 

While I would agree that it is entirely possible that TD could emerge after 6-10 months of dosing, I think it's highly unlikely. Additionally, given the timeline in which it emerged, which happened during the panic attacks and anti-cholinergic withdrawal symptoms, I think it's consistent with withdrawal-induced TD. I have said before, I am certain, no, 100%, the WE-TD happened at the same time I felt that the Latuda was no longer effective and treating any symptoms. 

 

I'm not trying to disagree with you for the sake of disagreeing, but I say this with the same certainty I have that my anti-psychotic withdrawal like psychotic symptoms are not like my original psychosis. That is, I just have a strong feeling that it's WE-TD and tolerance as opposed to typical withdrawal. 

 

So based on that hunch, you don't have to agree with me, would up-dosing produce any unwanted/adverse effects? Given that I think I've experienced tachyphylaxis, how could up-dosing effect me positively/negatively? 

 

Please take a look at the karger research journal that I have posted, it lists WE-TD as a criteria and symptom for super-sensitivity psychosis, given how long I've been dealing with the withdrawal emergent psychotic symptoms, and the timeline in which the WE-TD took place, I think it is extremely consistent and clear.

 

Additionally, I did not experience withdrawals going off of Latuda; I was experiencing panic attacks and withdrawal symptoms while on Latuda, which leads me to believe I experienced tachyphylaxis. Which had suddenly emerged after a month or so of taking the Latuda. 

 

[Oksnoh]

It does not make sense that TD would suddenly emerge, because I did not have any TD related symptoms in the past. TD would slowly develop over the course of time with prolonged use of anti-psychotics, it would have been much more predictable and preventable (at least, I could have alleviated it). However the rapid occurrence of my TD followed by the panic attacks, and the onset of psychotic symptoms gives me certainty that my TD was in fact the withdrawal emergent type. 

[Oksnoh]

So I stand by my question: Would up-dosing in the case of tachyphylaxis produce more harm, than good? Or is the only way to know is to try it. Additionally, if up-dosing fails would it put my tachyphylaxis and withdrawal at a worse position than I was, before? Would an up-dose fail produce lasting harm/prolong suffering/make things worse?

[Oksnoh]

As far as my psychotic symptoms, they have not developed and have remained consistently terrible. It has been 2 months since the onset and I've only just begun to windows of relief (though very, very infrequently). Please read my edit above in bold.

[Altostrata]

TD can emerge suddenly after a dosage increase, along with akathisia and other symptoms of excessive antipsychotic dosage, which you've reported.

 

19 minutes ago, Oksnoh said:

I'm presenting this hypothetical scenario because I'm fairly certain what I'm experiencing is tolerance

 

You cannot be in tolerance or tachyphylaxis and have withdrawal symptoms at the same time.

 

As noted earlier, I am unable to follow your reasoning about tachyphylaxis. You are not currently experiencing tachyphylaxis.

 

You have an alternate understanding of tolerance, tachyphylaxis, adverse drug reactions, tardive dyskinesia, and withdrawal that I do not share. I am unable to adopt your model, because it does not correspond to my research or experience.

 

When anyone takes a psychiatric drug or similar drugs for a long time, they tend to lose effectiveness as a natural progression of adaptation. The drug user may or may not notice this. The misnomer "tachyphylaxis" has been applied to the achievement of tolerance to a drug. The way to avoid tachyphylaxis is not to take a drug or similar drugs for a long time.

 

However, you have symptoms of psychosis and appear to depend on drugs, however minimal the dosage, to control them. As explained at length, you have a choice: cope with withdrawal symptoms or take a little more risperidone. You may or may not eventually develop tolerance (tachyphylaxis) to the risperidone. 

 

If you choose to cope with withdrawal symptoms and take 0.5mg risperidone, your nervous system very gradually will settle down from withdrawal over time -- duration unknown -- and adapt to the 0.5mg risperidone, but it is unknown whether 0.5mg risperidone will be enough to control your symptoms of psychosis. You would have to find out.

 

It is also possible that, over time, you will develop tolerance (tachyphylaxis) to 0.5mg risperidone, which may cause a re-emergence of your symptoms of psychosis, if in fact it has been controlling those symptoms. Over time, you may also develop tardive dyskinesia, even at this very low level of risperidone, but that is the risk of long-term antipsychotics for symptoms of psychosis.

 

So, your choice. I cannot tell the future.

 

19 minutes ago, Oksnoh said:

So based on that hunch, you don't have to agree with me, would up-dosing produce any unwanted/adverse effects? Given that I think I've experienced tachyphylaxis, how could up-dosing effect me positively/negatively? 

 

I don't know. It's your choice, updose risperidone slightly or cope with withdrawal symptoms.

 

As you have already found by experiment, a little more risperidone can quell your withdrawal symptoms. Since I cannot tell the future, I do not know what negative effects this would have. I also do not know how long it would take you to recover from withdrawal symptoms without the additional risperidone. I do not know if 0.5mg risperidone will control your symptoms of psychosis. As I have noted, you run the risk of new hospitalization.

 

Since it's already happened, I can say with some certainty that you are at risk for tardive dyskinesia from large doses of antipsychotics. I do not know the degree of risk with a minimal dosage of risperidone.

 

Personally, I have no investment in whatever course you choose. It's up to you. I cannot continue to respond to your many, many questions, I don't have time. I've answered as much as I can. If you have further questions, please re-read my responses before posting.

[Oksnoh]

I see, it was my understanding that during Tachyphylaxis, at least in antidepressants or benzos, withdrawal like symptoms would follow. I apologize, and thank you for your time, but could you explain in further detail? You said you can't experience tachyphylaxis and withdrawal symptoms at the same time. My understanding is that tachyphylaxis is followed by withdrawal-emergent symptoms. This is my last real question.

 

 

[Altostrata]

Your understanding of tachyphylaxis (more properly tolerance) is incorrect. The symptoms of tolerance are usually failure to provide whatever benefit the drugs formerly had. For example, benzos do not cause sleep where they had before.

 

Tolerance occurs while you are taking the drug. When you go off the drug, you cannot be in tolerance any more. You cannot still be in tolerance from Latuda. You are not in tolerance from risperidone. You probably have never been in tolerance from anything.

 

I cannot repeat corrections of every misconception you have about this. I have nothing else to add.

[Oksnoh]

Up-dosed last two days, felt temporarily relief but the crash today was awful; I could not stop crying for 3 hours. I’m having the feeling that the medication isn’t working anymore, at a loss for what to do… can’t get out of bed. I felt great last night for 5-7 hours after the up-dose. Today I feel horribly depressed, dull, hopeless, and am struggling with the disorganized thoughts (I previously presumed were from withdrawals, now I’m not so sure. They improve during my “windows of relief”, but could they be because of the tiny dose of Risperidone I’m on? I’m not sure. I really don’t know at this point; really wanting some relief. 
 

If I lower my dosage, withdrawals get worse. If I up the dosage, I may crash like this again and it might only work for a short while.. @Brassmonkey , what’s your opinion?

 

I am still convinced I experienced Tachyphylaxis, and the reason I’m experience withdrawals is not because I’m not in Tachyphylaxis, but because I effectively made a 50% reduction in terms of dosage of antipsychotics (I was on 20 mg of Latuda until it pooped out which is the equivalent of 1.0 mg of Risperidone, I’m only on .6125 currently). 

[Oksnoh]

It feels like my body is desperately fighting for homeostasis, and is confused as to what it wants. To move up or to move down. Withdrawals are telling me to move up, at the same time, my body feels like it doesn’t want the medication/rejecting it and wants to move lower and lower to get off the drug. Is this relatable to anyone?