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Seroquel and Risperdal question (Dr. G)
reneegigliotti posted:
Hi Dr. G

Can adding Risperdal (2 mg to be later increased to 4 mg) to a medication mixture of Depakote (2000 mg), lithium (1125 mg) and Seroquel (600 mg) improve psychotic depressions and psychotic manias? I always thought they were in the same family of medications. I had gastric bypass surgery 4 years ago so my doses skew high for that reason. I meant to ask my Dr. G the question, but we got onto many other subjects today and it escaped my mind. I thought I'd ask you. Hope it's ok.

Joseph F Goldberg, MD responded:
Dear Renee,

Risperdal has known value for psychosis and mania but hasn't been shown to treat depression symptoms (though it might help other symptoms associated with depression like agitation or anxiety). It is in the same family as Seroquel and is somewhat redundant with it -- kind of like taking Advil plus Aleve -- and both Seroquel and risperidone "compete" for some of the same binding receptors so it's not clear they would enhance each other's effect. Risperidone binds much more tightly than Seroquel does to dopamine receptors so it's possible that risperidone could "kick out" some of the Seroquel from their shared targets, and, if risperidone seemed to be more effective, then the Seroquel might be redundant and perhaps worth reducing. But, there is no harm in mixing them.
Dr. G.
reneegigliotti replied to Joseph F Goldberg, MD's response:
Thanks, I'm not sure what his goal is. He's very careful about prescribing so he's thinking about something. I just don't know what that something is. I should have thought to ask yesterday. You MDs can be so inscrutable sometimes.

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