Friday, October 17, 2008

Risperidone Boosts ADHD Stimulant Medication Effects

ADHD Medications

We often search the fine print for ADHD medication labels to see if there are potentially negative drug-drug interactions. However, an equally valid question may be: are there other medications which may boost or augment the effectiveness of an ADHD medication while keeping negative side effects to a minimum? The answer to this question appears to be "yes". We have seen in a previous post how ADHD medications and treatments can often overlap those of co-occurring disorders, such as in bedwetting. We have also seen how Atomoxetine (Strattera) can be an effective treatment option for ADHD and Tourette's. We have also explored the relative safety of ADHD stimulant medications taken during pregnancy. Now we will discuss is which medication strategies are effective for ADHD and comorbid conduct disorders and evaluate the relative safety of these medication combos.

The drug Risperidone (also referred to as Risperdal or Rispen), is a relatively new antipsychotic medication which was released in 1993 for adults and was approved in 2007 as a treatment option for both pediatric schizophrenia and pediatric bipolar disorders. A year prior to this, it was used as a potential treatment medication for pediatric autism. Given the fact that individuals with ADHD are more prone to exhibiting multiple symptoms of these disorders, Risperidone is a potential agent of interest for certain forms of ADHD.

A key study was done in 2004 by MG Aman and colleagues and was published in the Journal of Child and Adolescent Psychopharmacology, which focused on the effects of Risperidone when used in conjunction with other stimulant medications for treating ADHD in children of sub-average IQ's during a 6-week study period. Additionally, differences in behavioral disorders frequently seen alongside ADHD, such as Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) were also monitored by the study.

Although not a stimulant medication itself, the study's findings suggest that Risperidone may prove to be useful in augmenting these stimulant medications' effectiveness for these disorders or combinations of disorders. Additionally, results from the study suggest that Risperidone,by itself is often an effective treatment for hyperactivity and conduct disorders that often occur alongside ADHD. When combined with stimulants, the overall effectiveness is even greater.

Safety-wise, the study found that the use of Risperidone produced no noticeable change in the number of stimulant-related adverse drug effects. The three main ADHD stimulant medications used in the study were Methylphenidate, Pemoline, and Dextroamphetamine, with levels for each medication covering a wide dosage range. It is first important to note that while methylphenidate and dextroamphetamine are both considered to be relatively safe stimulant medications for treating ADHD, Pemoline (Cyclert) is known to be potentially harmful to the liver, and is typically used sparingly, often as a last resort among many physicians. What the study observed, however, is that risperidone, when taken alongside these stimulant medications, does not increase the number or severity of these side effects (Risperidone treatment did result in slightly more weight gain than the placebo controls, but the overall difference was small). This should be taken as good news for those concerned with the overall safety and effectiveness of combining stimulant and non-stimulant medications.

While ADHD stimulant medications and antipsychotic agents have different modes of action and different biological "targets", the results of this study suggest that the two types of medication are often able to work together and improve each other's effectiveness, while incurring minimal side effects. This suggests that for children with both ADHD and some type of oppositional or conduct disorder, prescribing Risperidone along with a stimulant medication such as Ritalin, Concerta or Dexedrine may be a highly effective and relatively safe treatment option.

ADHD medications

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Penny Williams said...

I find this article (and your entire site) very fascinating. I arrived here because my son, 9 years old w/ADHD, dysgraphia, SPD and gifted IQ), has tried all stimulants and many alternative medication treatments (and alternative treatments) over the last three years with more problems than benefits.

Here's detail in a nutshell:
1. methylphenidates are fantastic at first then lose effectiveness over short time (approx 3 months). he has been gluten-free for about 5 months but that has not helped. Concerta is the best of this category.
2. Amphetamines, even at the lowest dose, make him aggressive, violent, and angry, traits he didn't have prior to taking meds for ADHD.
3. we've tried adding other types of meds with serious side effects: Celexa gave him a psychotic episode, Imiprimine made him so fearful he wouldn't leave my side and would cry seemingly for no reason, Straterra made his moods cycle drastically. Intunive made him irritable and gave him nightmares. Kapvay was bad (but can't remember the details). All of these meds were in addition to Concerta.
4. Short-acting stimulants have a very bad effect on him. No benefit at all.
5. some natural supplements that affect dopamine made him angry and irritable.
6. He currently takes 36mg Concerta and we have added Trileptal. We were building up to therapuetic dose of two full tablets by giving 1/2 tablet and increasing by that amount every three weeks. Once we reach two 1/2 tablets his hyperactivity and talkativeness went through the roof. His doc said to go straight to the two full tablets one AM and one PM. Today is the first day of that but his stomach hurt so bad he couldn't go to school.

The idea of Risperdone scares me, especially for a kid who doesn't have a mood disorder, but now you have me thinking this may be beneficial.

My other thought is that the stimulants are the problem with all the other meds we've tried.

Any thoughts? said...

"...the two types of medication are often able to work together and improve each other's effectiveness..." Though the studies show a good team between the two against ADHD. Caution should be paramount. I have seen many drugs and drug combos come along and even with data that existed back then, some turn out to be disastrous.

Anonymous said...

Hi Penny,

What you describe matches EXACTLY what we have experienced with my 10-year old son. My son has severe ADHD, ODD and Tourette's. He is now on Concerta 36 mg + Risperdal 0.75 mg (0.5 in the morning with the Concerta and 0.25 mg at dinner time). The Risperdal has been our only ally in reducing the aggressive behaviours, irritability and outbursts most of the time. It has also helped with his appetite which was quite affected by the Concerta. Unfortunately, the drugs do only half the work and intense counselling is needed, both for my son and for the rest of the family, not because we are bad parents as many websites and others will say but because dealing with a child that suffers from these diseases is extremely difficult and exhausting. I am sure you can relate. Hang in there and good luck with your son.

An understanding mom.

LilaTovCocktail said...

Penny: Just the same with my 9 year old son: gifted IQ, dysgraphia, SPD, and now ADHD. But he also has Generalized Anxiety Disorder. We're just starting the medication process, and although I am a psychotherapist with an MA in Social Work and furthermore take a med for ADD myself, I'm finding the process as it applies to my child really scary.

The first thing we tried, last week -was Vyvanse. 20 minutes after taking it, he began talking, and talked continually until 7 hours later, at which point he had a major tantrum. This weekend we're trying Focalin.

In reading the comments of other parents in other forums, I've been surprised and disturbed by how many people are getting their children's meds from a GP or pediatrician, and not a psychiatrist. This is a field with so much new data emerging and so many new drugs hitting the market with regularity that you need specialize in it to have the time to keep up. You really want a doctor who does ONLY this and knows what she is doing, a doctor who isn't just relying on the drug company reps for their information.

That's all I've got in the way of advice, that and empathy and best wishes.

Samantha said...

My 7 year old was diagnosed with ADHD and severe mood disorder over a year ago. We went through dozens of medications and combinations of medications and have finally found a combination that works. He takes 30 mg Vyvanse in the morning and 1 mg risperidone at 2pm. He's been on this combo for 3 months now and it has done wonders for him. He's now getting awards at school instead of referrals. They want to place him in the gifted program. He has come a long way and we are very proud of him. I was worried at first ad out all the meds. I didn't want him to be a zombie on the meds. But we still have our laughing, smiling little boy. But now he can focus and doesn't get violent anymore or hurt himself. He sees a therapist every other week which also helps.
Having a child with ADHD and severe mood disorder can be a chalange especially when trying to find medications that work. It may take a while to find that right Med or combo that works but don't give up. There is hope. It may not seem like it and believe me I know. It took us a year and a half to get to this point. It was bad. To the point that he was expelled from school in kindergarten and we were told that we should have him put in the hospital. Talk about a heart breaker. Now we know what works and can can go from here. He is so much happier now.

Anonymous said...

I am reading a lot of parents talking about their children on here and I think it's great that these kids are getting help at such a young age. I wish I had that sort if help when I was young. Things may have turned out different for me. I got pretty lucky though and probably wouldn't change the end result, but my god, my life didn't have to be such a struggle to get here.
I have adult ADD and ODD and was diagnosed at age 37. I have been on concerta for about ten months, and have been adjusting my meds the whole time. Concerta works very well for me but I have to constantly monitor how I am doing. Sometimes I need more, sometimes less. It all depends on the activity for me. Certain activities naturally release dopamine for me and some turn my brain right off. I have recently added risperidone to my mix with some reluctance. Being told I need to take an anti psychotic drug really bothered me, but methylphenidate on its own wasn't the complete answer. My wife likes me best on both. The key to this disorder is finding the right dosage. When I am correctly medicated my life seems so easy and I'm not fighting with my wife at all. Improperly medicated, my life is a disaster.
I would like you all to know that when my meds are right I feel more like myself than I could ever have hoped. The mood swings are gone.
Don't give up on the treatment. Find one that works and tweak it as needed. My therapist believes that its like being diabetic. The patient learns to adjust his meds as needed. Everyday is different and brings challenges but with understanding and the right tools life is so much better.
Good luck all
And remember that your children want to fit into the non-ADD world, we just don't quite know how yet:)

Anonymous said...

My son has ADHD & Tourette's Syndrome. He is now 9 years old. He takes Concerta & Risperidone (to control his tics). He has been taking these two drugs together for 3 years now, without negative side effects & tremendous effectiveness. This followed negative experiences with Aderall, Straterra, & Clonidine. Each child is different, but this combo was a godsend to him & our family.

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Anonymous said...

My son has just been diagnosed with ADHD and SPD. We are starting on Rispirdone next week after a lot of hesitation. He was asked to leave 2 daycares because he was hitting teachers and has just started prep this year and been suspended twice already. They had to call the police the other day because he ran away. Hope this medication works :-(:-(

Charlie said...

It makes me feel sad to know how many parents are drugging up their children. Some of you treat your children as lab rats and go through so many types/combinations of meds.

These drugs have negative consequences for childrens long term health. Heads up: THE DRUG COMPANIES ARE NOT GOING TO TELL YOU THIS! NEITHER ARE THE DOCS PRESCRIBING THE MEDS!

My son was diagnosed at 4 yrs old with ADHD. Later diagnosed with ODD. His mother had custody at the time and is on all sorts of meds herself so of course she was all for doping him up. Concerta, up to 36mg a day. Then we began sharing custody. At the beginning of this arrangement his mother wanted to add risperdal to the concerta because he was always misbehaving at her house. Key word here- HER HOUSE. Nothing major at school, other peoples houses, etc... Due to the shared custody I was able to stop risperdal from being introduced. His pediatrician is hilarious! Sit there for 3-5 min while she asks you some questions. Then ask the kid a few useless questions and BAM- the prescription pad is warmed up and ready lol.

My new wife is a CYW who has many years experience with children. We now have hime down to 18mg/day and he behaves better than he was before due to active parenting.

I am not saying that ALL children taking meds dont need to. But I am confident that when it comes to something specifically like ADHD, ODD, etc.. these "behavioural" diseases, that 90% of the time meds are the easy way out and not necessary.

High quality, unprocessed foods, good sleep patterns, exercise, proper parenting techniques. (not video game/tv parenting) These are some of your cures for behavioural disease.

Melissa said...

My daughter is four she will be five in February she has been on risperidone since she was two this last Monday the dr took her off and started her on methylin and she has been taken it for four days now and I am near tears today the outburst have started again and she just seems so mad at everything I don't think he should have taken her off the other bc that's what she needs it for is the mood disorder I am so lost this has been a hard on going battle for years and him taken her off of it scares me bc she has a younger brother who I couldn't put down bc she would take her anger out on him what should I do

Anonymous said...

My son is twelve years old and he was diagnosed one year ago with mood disorder,odd,chronic depression,add,adhd, and anxiety disorder. He has been on risperdal for a year and has had many adverse affects. He has ha ear problems,congestion in both,dandruff that's uncontrollable,fast heart rate,restless feeling in extremeties,spasms in his extremeties, painful erections,blood in his urine,constipation,cold feeling and clammy skin,complains being cold all the time,even when its warm out,weight loss,loss of appetite,and cough...altho the medicine does seem to calm him down when he is angry or upset..the outbursts aren't nearly as bad..and he seems more tolerant to things,but the side effects are so bad I really want to find an alternative drug that can have same effectiveness but have less dangerous and annoying side effects if anyone can offer advice or any help regarding this matter id be greatfully appreciative. I'm just a desperate mother trying to help her son feel better and be the child he used to be before risperdal. Concerned mom

Anonymous said...

Wow I can't believe how many children suffer with this terrible disease.I too have and still do struggle with my son who is now 10 yrs old.The signs began in kindergarten. His teacher saw that he couldn't stay seated so she let him stand and learn.By first grade signs were more on going.So I began my journey of months having h tested
He tested Adhd .Then the meds began
He started out lowest dose of concerta. He was able to focus and control behavior.Very happy boy always played outside with his friends.He's on 54mg now and .05mg of risperdal.He's handling behavior better and he's not showing signs of anger or solitude.He's in special far since the risperdal was added its seems to have taken away anger burst outs. We also attend counceling wkly to help me cope and assures him somebody really understands him..This has been very trying on us but we try everday to talk about his feel kings.Yes he's still moody and he can push my buttons nut I know God is here and that keeps me strong at my weekest times.I also believe his junk food adds to aggressive mood swings.Red dye !! Hot tacquies I let him have a little.I believe by doing this his system would be imuned.Everything in moderation.He needs to be a normal kid and not use Adhd as a downfall nor an excuse for bad behavior.I'm learning so much from this.Just want to say God Bless to all of you out there faced with difficult days and I pray all our children have happy childhoods and grow to be someone we all be proud of
God has gifted me with my son and I know he's very special.God Bless Our Children...

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Unknown said...

My son is 8 years old with high functioning Autism spectrum disorder and putting him on the cocktail of respiridone(.5 mg in am) and concerta (.25 mg in am with the respiridone and .5 at dinner) had caused him to have diagnosies of ADHD, OCD and diagnosies of schizophrenia and accute anxiety disorder. These poisons being perscribed to our children are not only making them worse but they are slowly killing them. I obtained custody of my son after his mother kept feeding him pill after pill and drugging him up so much that he couldn't even pay attention to a person looking him in the eye and talking to him. The only symptom he had with his original diagnosis of ASD was a fear of interaction with people. All of these "medications" (which, if you actually do research on, are toxic to humans in even minute doses!) are perscribed by doctors who recieve bonuses from the drug companies that make them for every pill they perscribe. All of you people need to stop turning to greedy doctors and paying for their third summer homes with your childrens health and possibly their lives, hope it doesnt happen to any of you. since getting custody of my son i have taken him off the pills, which were highly addictive and made him go through withdrawl, and have put him on a diet with supplements to give him the 90 essential vitamins and minerals the human body needs to be healthy. Within a month of him being on this diet his diagnosies have changed. He is no longer suffering from anything but ASD but he has shown so much progress and no longer has fears of interaction with other people. It is hard watching your child go through these symptoms and the withdrawl was the worst, but if you stick with it and teach your children how to eat properly and take care of their bodies it will pay off in the end. If you want me to share the diet and supplements i used, I can't because it was specific to my sons deficiencies and over abundance's in vitamins and minerals. What i can tell you is that you should take your child to a nutritionist not a doctor because 75-99% of these disorders are caused by heavy metals like murcury and arsinic in our bodies and brains, which come from the food we eat. Your body produces an anti-oxident called "glutathione" which helps flush heavy metals out of our bodies and brains. The last thing i have to say is don't be lazy and dependent on medical "professionals" who have little to no intrest in making us healthy, like my sons mother was. She cost herself a relationship with my son because she was too lazy to educate herself on these matters. I am not a doctor and have no degrees at all, I am a metal worker who makes less then 4000k/year with 4 children and suffer from ASD myself who had the want to fix my sons broken body and was willing to go to whatever means necessary to make sure he gets a better life then I have had.

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Anonymous said...

I'm not sure how I haven't found this blog/site sooner. This post in particular and many of the comments have been quite helpful. Like many others here, my son is now 10 and has been living with ADHD and ODD since he was 6. At age 8 we started seeing more anxiety and aggressive behavior. He was on Concerta at the time and very introverted, angry, and afraid to go outside or be with other children. We started on low dose Risperidone and the difference was night and day with him: wanting to meet the kids down the street, friendly and affectionate. What was surprising was the weight gain - 40 lbs in less than a year. He still has some anxiety (part now due to being overweight) and mild ODD-related traits, but my happy child is back.

I was concerned when our doctor suggested risperidone and leery of adding more medication to the mix. I researched and talked to other parents and health professionals with similar experiences before deciding to proceed. The weight gain concerns me but is stabilizing (at least not increasing) and the improvement to his behaviour, overall mood, and outlook on life with risperidone is significant.

As a parent, it is difficult to watch your child struggle and harder still when all attempts to help or alleviate their struggles go in vain. Choosing to medicate is not an easy choice especially in our society which seems to think mental health issues can always be cleared up with hugs, fresh air, and exercise. It is encouraging to read that treatment is available and other children with similar challenges are seeing similar results.

Troy Haliwell said...

I am a 48 year old adult male with pure ADHD.

I am on 36mg Concerta and 100 mg Strattera. My ADHD symptoms are pretty much under control, and do not experience mood or anxiety issues (other than those that a non-ADHD would also experience, such as elections and such).

I had only been on the Concerta 36 mg and it resolved a number of symptoms, but not all of them, and the Strattera added was what I needed.

jade said...

In my own personal experience, this has resulted in a significant decline in levalbuterol orders within the hospital setting. I have yet to look into this, although I would imagine levalbuterol sales have declined. I will look into this later.less side effects

Unknown said...

I have the same with my 5 year old and medication is Ritalin and risperdone just started. Yes meds are not the full answer but I with my eldest daughter need lots of counselling with little Chloe just to get through. Its a struggle and we are not bad parents and we do the best we can with the struggles of her behavior aggression and outbursts. Its a long road for us but its gone on since she was 3. Thank you for telling your story.

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Unknown said...

I am having issues with my 7 year old son. He has been on the gamut of ADHD meds (Ritalin, Concerta, Vyvance, Adderall, now Focalin) for over 3 years. Without meds he is OVERLY hyperactive. He has gone for over a week with no sleep before meds were introduced. He is currently on 25mg of Focalin XR in the morning, .2mg of Clonidine at night for sleep, and 20mg of Fluoxotine at night for moods. I am finding the night meds aren't as effective at either getting him to, or keeping him asleep. Also, the Focalin XR seems to wear off after just 7 hours which leaves the last 1.5 hours of his school day (extended day program for Gifted kids) with little to no med in his system. I need to know if there are meds available to give him in the afternoons to help control him a little so he can function through the remainder of his day at school without issue. It would help if we could find a better sleep alternative for him as well since the current setup isn't working anymore. Any ideas?

Anonymous said...

Those of you drugging your children are A. some seriously sick indvididuals, or b. gullible idiots who should not be allowed to breed. STOP DRUGGING CHILDREN. THIS IS NOT MEDICINE.

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