Dr. Aneel Kumar
Psychiatry
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Patient's Query
Hello doctor,
Ropinirole to boost dopamine after Paliperidone treatment for schizophrenia?
I am a 46-year-old male. I have been in hospital a couple of times recently, in their judgment I was quite unwell (paranoid about spooks after certain events), diagnosed with schizophrenia (though I am not sure, although I was extremely paranoid), and they put me on a CTO for injections of Paliperidone, which I have been on for the last 18 months or so. 100mg I believe for 6 to 12 months, then 75 mg for six months, and now on the lowest dose that it comes in and have been completely free of thoughts of spooks for nine months, so I am well. But I notice that I seem to be a little zombified due to the effects of the drug, and am worried about Dopamine impact (an important chemical), and frankly, I would like to try to help restore Dopamine to a healthier level. I am not sure that is going to happen naturally, so was wondering about a low dose of a Dopamine agonist like Ripinirole for perhaps a year or so, to get things moving in the right direction. Whether this would actually help restore dopamine function though I am not sure. Also, it can increase the chance of psychosis, hence the preference for low dosage. What I am after then is some brief comment on whether you would recommend this or not (at a glance), or something else. Any comment would be appreciated.
Hi,
Welcome to icliniq.com.
Taking Dopamine agonist to restore dopamine level in the brain after giving antipsychotics for schizophrenia is not a suitable choice because of relapse of psychotic symptoms or exacerbation of symptoms not only psychotic symptoms but mood symptoms, these side effects are called extrapyramidal symptoms which can be managed to give anticholinergic medications along with antipsychotics, better to visit your treating doctor to have healthy discussion on this.
Patient's Query
Thank you doctor,
I would only be taking the Dopamine agonist at a low dose, and would stop it immediately if there was any sense of relapse. So I do not know if I would be too worried about relapse. Even though I realize that would be your main concern (it is reversing the effect of the treatment after all I suppose).
What does worry me though, is your mention of extrapyramidal symptoms, which includes shaking. I would not want that to become a problem by taking a Dopamine agonist. Your opinion seems to be that follow-up with a Dopamine agonist would put me at significant risk of shakes? Even at a low dose? I noticed that a research paper showed that the combination of stimulant and antipsychotic, caused acute dystonia.
Hi,
Welcome back to icliniq.com.
I think you have to understand it more, you have been treated for schizophrenia with Antipsychotic medication called Paliperidone is a Dopamine antagonist to control the psychotic symptoms, Antipsychotic medications (not all) cause extrapyramidal symptoms like acute dystonia, akathisia, parkinsonian symptoms, tardive dyskinesia, depends upon type of antipsychotic, dose, duration, and many other factors too, taking Dopamine antagonist is not a suitable choice in this condition rather control these symptoms with anticholinergic medications along with antipsychotics and the other healthy strategy to switch the antipsychotic medication which has less not no such side effects like Ziprasidone, Lurasidone,and few other options.
If Dopamine antagonists are advised that should be monitored during regular visits with your treating psychiatrist, and schizophrenia require long term medications along with psychotherapy sessions after symptoms have recovered, and family support and family account is very important in this.
Patient's Query
Thank you doctor,
Seems there could be misunderstanding. You are saying that I should be worried about extrapyramidal symptoms being on a treatment of Paliperidone, and that they can be controlled. Fine. But my question is, once I have stopped the Paliperidone treatment, in order to reverse the effects of the Paliperidone and restore dopamine function, would it be safe (apart from relapse), and effective, to go on a low dose of Dopamine agonist?
Hi,
Welcome back to icliniq.com.
You should not be worried rather a concern to visit your treating psychiatrist to have an alternative to Paliperidone as I discussed in the previous message, because stopping antipsychotics can cause risk of relapse of psychotic symptoms, as I said giving Dopamine agonist is not a suitable choice, rather to switch the patient to other antipsychotics to deal with schizophrenia and since you would not have Paliperidone in your body and anticholinergic for short period of time to deal with side effects and dopamine itself reverse, this would happen when you visit your psychiatrist personally to have healthy discussion along with your family members, and yes in certain condition like permanent parkinsonian symptoms after a long term use of antipsychotics can be deal with dopamine agonist. This should again be discussed with your treating doctor and if you do not want to go to your doctor then discuss with your family to have other expert opinions, personally and extrapyramidal symptoms need to be assessed physically.
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Psychiatry
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