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.
