QUESTION:
Dear Dr. Heller:
I am presently taking Prozac 60 mg with good effect. On occasion I suffer from severe “dysphoria” which I treat with Zyprexa PRN. Taking Zyprexa only as needed is helpful and kicks a dysphoric spell somewhat quickly.
I see in your other articles that you recommend Haldol on a PRN basis. Is there a difference? Is Haldol superior to Zyprexa in BPD? I, myself am not worried about the weight gain of Zyprexa. Aside from that side-effect, is there any major differences with these two drugs? I know Haldol is a typical and Zyprexa is an atypical antipsychotic. Also, how about Risperdal? Is this comparable or better in any measures?
ANSWER:
First I want to say how thrilled I am that you’re taking an antipsychotic medication on an as needed or “prn” basis. It’s a crucial part of successfully treating the BPD.
Zyprexa can work that way, although it usually takes 60-180 minutes to work. The weight gain is a huge problem, as is expense. Many people complain they don’t “have any feelings” while taking it, and it tends to make patients very groggy.
Risperdal is great on an as needed basis. When an SSRI (particularly Prozac) is in the system and a severe crisis develops, Risperdal – usually at 3mg – has no equal in this regard. Side effects are a problem at this dose and I warn patients they may be groggy and non-functional for a day or more. Interestingly Risperdal is rarely effective on an as-needed basis if taken daily.
Haldol is a typical antipsychotic, which means cumulative dose is more likely to cause a problem with tardive dyskinesia than Risperdal or Zyprexa (weight gain from these two medications can cause diabetes and resultant heart disease, arthritis, high blood pressure and stroke – these medical complications need to be taken into account.) Haldol in low doses has been shown in the literature to work on an as needed basis for transient (or temporary) psychosis. Side effects are rarely a problem and the individual is usually able to return to work or family life in 5-10 minutes with the dysphoria (anxiety, rage, depression and despair) gone and without impairment.