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Can antipsychotic cause ADHD symptoms?
29. Male. 5'6". 74 kg. Currently on paliperidone 75 Mg monthly depot injection.
My thinking is antipsychotic (paliperidone) that I am taking is causing me to have ADHD-like symptoms (for example to be bored easily). I have read that paliperidone blocks d2 receptor but can have effect on ADHD symptoms which are caused by low dopamine by d1 receptor blockade. I asked my treating psychiatrist he says paliperidone doesn't affect D1 receptor in mesocrtical pathways which are implicated in ADHD? Who is correct ? I wanted a second opinion.
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Paliperdone is primarily D2 receptor antagonist and 5 HT2A Antagonist. It's strongest action is blocking D2 receptors in the mesolimbic pathway which reduces psychotic symptoms
ADHD on the other hand is thought to involve under activity of dopamine and nor epinephrine in the prefrontal cortex, especially through D1 receptors pathway
Paliperdone does not block D1 directly, it's main target is D2 Receptor.
By blocking D2 indirectly especially in the mesocortical pathway, paliperdone indirectly reduce dopamine signaling in the prefrontal cortex.
So Indirectly by lowering dopamine tone, it can contribute to poor attention, lack of motivation, memory problems, cognitive slowing, reduced concentration which overlap with ADHD like symptoms
This is why patients on antipsychotics report slow thinking or difficulty in concentrating. It's not classic ADHD, BUT RATHER A SIDE EFFECT OF DOPAMINE BLOCKAGE.
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Share this concern openly with your psychiatrist sometimes the dose adjustment or adding a medication can help balance these effects like certain cognitive enhancers
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Hi.. symptoms are different from syndrome. So you can have a symptom.. inattention, doesn't mean you have adhd. However will need further history regarding the same to advise appropriately. Consult online for questions regarding the same
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First of all , I will suggest not get confused by net information
* It is not ADHD symptom, to get bored easily*
May be you are feeling lethargic or less active, or not feel drive to initiate task"
" You must discuss your symptoms as in your words not scientific terms, what exactly you feel or face/"
Along with depot, may be other medication will be needed, depend on your present symptoms and progress or improvement of past symptoms/"
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Dr. Niharika Singh
Psychiatrist
5 yrs exp
Delhi
Antipsychotics can cause restlessness which is a side effect and that may mimic restlessness in ADHD. Its treatable.
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Dr. Anil Kumar Yadav
Neuropsychiatrist
19 yrs exp
Bilaspur
Paliperidone / Risperidone
Strong D2 blockade, minimal D1, 5-HT2A antagonism
May cause cognitive dulling at higher doses
Can cause amotivation / boredom / apathy
Moderate risk (indirect dopamine suppression
Aripiprazole
D2 partial agonist, 5-HT1A agonist
Neutral to mildly pro-cognitive
Less likely to cause apathy (can feel more âenergizingâ)
Low risk â sometimes helpful in ADHD comorbidity
Lurasidone
D2 blockade, strong 5-HT7 antagonism (pro-cognitive), 5-HT1A agonist
Best evidence for cognitive benefit in schizophrenia
Less sedation, relatively motivation-friendly
Clozapine
Weak D2, strong 5-HT2A, muscarinic, histamine
Mixed: can impair memory (anticholinergic), but improves negative symptoms
Improves motivation in resistant cases
Moderate risk (due to sedation, anticholinergic effects)
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