QUESTION:
Dear Dr. Heller,
I got Haldol 2mgs from my psychiatrist for dissociation and dysphoria. Now I hear from my therapist (4th year resident) that something awful can happen to me unless I take something called Cogentin with it. I thought that only if you’re on Haldol every day could something bad happen, but he said that even for one dose I can get something called torte- (I don’t remember the rest of the word but he did a demonstration where his body was twisted and his tongue sticking out). Now I am afraid to take Haldol because my medical Doctor did not prescribe the antidote to be taken with it. Although I am on Wellbutrin and 10mgs of Prozac every day, I am suicidally depressed.
ANSWER:
Your therapist’s immaturity is showing. It was an extremely inappropriate thing to say. Your psychiatrist did the right thing, and clearly has your best interests at heart. I commend your psychiatrist for giving you as needed medications to stop dissociation and dysphoria (anxiety, rage, depression and despair). Everything in life (and especially with medicine) is balancing risks against the benefits. It’s dangerous to drive a car, but the benefits usually outweigh the risks. When you turn on the hot water, the pipes could explode. It’s highly unlikely, but it could happen. You perceive the benefits as outweighing the risks. Rarely does Haldol cause a side effect called a “dystonic reaction”. This is a temporary imbalance in dopamine in a separate part of the brain that are called the basal ganglia. Dopamine blockers like Haldol cause a relative imbalance with another neurotransmitter called acetylcholine. It can be blocked with a medicine like Benadryl or Cogentin. Since it rarely happens, using Cogentin or Benadryl whenever you take the Haldol is only necessary when the individual gets a reaction at a specific dose. This side effect is often dose related. The dysphoria instruction sheet I use for my patients explains this. Long term daily use – particularly in the elderly – can cause a serious neuromuscular disorder called tardive dyskinesia. The risk is small but real. The risk of suicide or self-destruction from not treating dissociation and dysphoria (anxiety, rage, depression and despair) are also very real. What I do with my patients is add Tegretol when they need lots of Haldol. Here is the medication sheet I give to my patients.
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