QUESTION:

Dear Dr. Heller:

I wrote to you before about my 15 year old son's experience in 1999 taking Zyprexa, Seroquel and Zoloft for depression and psychotic thoughts. Doctors think it's schizophrenia. The whole year treatment did no good and he gained 70 lbs. He's been on Prozac only for a couple of months. While better, he was still not right and said he felt miserable most of the time. We added BuSpar for 2 weeks just recently and while he felt much better it caused unacceptable behavior at school and didn't help him focus so he could study or do any work at all. Now yesterday we started on Risperdal, 1mg,. my idea is to get control of the psychotic thoughts with in 2 weeks then start him on Ritalin. I'm afraid the side effects of Risperdal will be eating and sleeping like the previous medications.

Before the recent problems in school his doctor had agreed to a 30 day trial on Ritalin to see if he could focus on something other than video games. The day before we were due to start the Ritalin he had a psychotic episode (talking and laughing to himself, hallucinating pictures in posters moving), etc. Despite this, the next morning I gave him one pill of Ritalin. He got up by himself (unheard of), and shortly after, made his bed and got out of his pajamas and appeared normal until about 11:00am when he started eating and acting odd. I was afraid to give him his Noon pill because the doctors say it will make his psychosis worse. I saw on pg. 378 of your book "Biological Unhappiness" you prescribed, for much the same symptoms, Prozac, Risperdal and Ritalin.

In your opinion, can my son safely try Ritalin after 2 weeks on Risperdal? It does no good to eliminate psychotic thoughts by incapacitating the patient as has happened in the past with anti psychotic medications. Hopefully the Risperdal will be different, but I must plan for the worst.

Many thanks for your time,

C.

ANSWER:

While I clearly don’t know your son, the BuSpar side effects are to me the most significant finding. What I’ll usually do for my patients in this situation is stop everything except the BuSpar, and start on a lower dose gradually moving up. Prozac can then be added without the side effects. Seroquel can be used temporarily during this time, and will assist with BPD dysphoria (anxiety, rage, depression and despair), schizophrenia, and bipolar. Ritalin can be used safely once the full dose of BuSpar is in the system for a week without side effects (15mg twice daily).