Zoloft and Risperdal for OCD in Children

Reader’s Question

A twelve-year old family member has been prescribed Zoloft for anxiety and OCD. Risperdal was added to counter the Zoloft side effects of paranoia and hallucinating. After six months of taking two drugs in addition to counseling, his anxiety and OCD are under control. However, he has just developed a tremor from the Risperdal. When the Risperdal dosage was reduced slightly, paranoia and hallucinations returned. My question is would it make sense to reduce the Zoloft at the same time? Are there other options that might be discussed with his doctors?

Our Consulting Clinical Psychologist’s Reply

My first consideration — are the medications being prescribed by a psychiatrist? A psychiatrist is best qualified to use these medications in combination. The disorders (anxiety and OCD) and symptoms (hallucinations and paranoia) you mention are related to neurotransmitters in the brain. Many of our current medications influence one, two or even more neurotransmitters. As you discovered, Zoloft concentrates on Serotonin to improve depression and OCD yet also increases Dopamine which can produce hallucinations and paranoia. Prozac, for example, works the same way on Serotonin yet decreases Dopamine. While I’m not a physician or psychiatrist, I can suggest that using Risperdal for the side effects of another medication in a 12 year old is very unusual.

There are many medications available for anxiety, depression, and OCD. If the child is not being seen by a psychiatrist, I would recommend this as the first priority. If a psychiatrist is involved, I would ask that he/she explore options for other medications that would not create the need to use something like Risperdal to counter side effects. There are many medications for OCD and anxiety that do not significantly influence the Dopamine system.

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