Bipolar Beat

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Last week, we started our coverage of the atypical antipsychotics with one of the more popular and controversial medications in the group – Zyprexa (Onanzapine). Because that post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.

Like Zyprexa and the other atypical antipsychotics, Risperdal was developed primarily to treat schizophrenia and psychosis but is approved to treat acute bipolar mania and mixed episodes (mania and depression). Risperdal can improve symptoms of schizophrenia and psychotic breaks that may occur in bipolar, including the following:

  • Hallucinations (audio and visual)
  • Delusions
  • Disorganized thinking
  • Paranoia

It may also improve conditions such as social isolation, limited motivation, and reduced speech activity for some people.

Risperdal can also improve symptoms related specifically to mania, including the following:

  • Irritability
  • Elevated mood
  • Impulsivity
  • Racing thoughts
  • Inflated self esteem
  • Decreased need for sleep

Like other medications in this class, Risperdal can help in the treatment of bipolar in two ways – by treating the mania and by reducing cycling (the switch from baseline mood into either mania or depression).

Although Risperdal has not been approved specifically to treat childhood bipolar, it has been approved to treat children and adolescents for irritability related to autistic disorders – temper tantrums, rapidly changing moods, aggressive behavior, and self-injury. It’s also been used to help treat Tourette’s syndrome.

This class of medications (the atypical antipsychotics as a group) has come to be used broadly to address issues of severe mood regulation deficits including uncontrollable tantrums and rages in both children and adults, even without a clear diagnosis of one of the FDA approved indications for using Risperdal: schizophrenia, bipolar disorder, and autism. I often describe it to my patients as a powerful “engine coolant” that helps to tone down highly aroused emotions and the behaviors associated with those emotions.

Caution: Especially in child psychiatry, we must carefully weigh the risks of these medications with their potential benefits. The metabolic issues with weight, insulin, and lipid changes can cause significant life problems for individuals on Risperdal. If someone is diagnosed with schizophrenia, they will have to take something in this family and manage the risks. In bipolar disorder there may be other medications that will work as well, but often this family of medicine becomes essential to managing the illness.

In children with autism we try to use alternative interventions as much as possible before going to these medications because of the risks. Unfortunately it has become a little too easy for us to prescribe these it seems, and a recent study indicated that Risperdal was being used for indications such as ADHD, which do not warrant such high risk medications.

Risperdal is a very important tool in my therapeutic toolbox. I have found it to be a typically reliable method of helping in situations of severe mood and behavioral dysregulation and bipolar disorder and aggression and irritability in autism. It even has use in some of the more severe anxiety disorders, including OCS. However, it also reliably causes weight gain, and this must be discussed openly and monitored carefully whenever this medication is used.

Like other atypical antipsychotics, Risperdal has the potential of producing negative side effects, including the following:

  • Weight gain is the most prominent and unpleasant side effect.
  • Increased risk of developing metabolic syndrome (pre-diabetes) and diabetes and problems with sugar metabolism.
  • Increased cholesterol and other changes in fat and lipid metabolism.
  • Movement problems like Parkinson’s disease (tremors and stiffness) (lower risk than older medications).
  • Irreversible uncontrolled movements called tardive dyskinesia – facial twitches or uncontrolled movements of the tongue, lips, arms, or other body parts (lower risk than older medications).
  • Akathisia – a feeling of extreme restlessness commonly described as the overwhelming desire to “jump out of your skin.”
  • Changes in cardiac rhythms.
  • Increases in the levels of the hormone prolactin – sometimes causing breast enlargement in men and lactation or menstrual problems in women.

If you’ve taken any form of Risperdal for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.


Related Posts

You can leave a response, or trackback from your own site.

Links to This Article

From Psych Central's Dr. Candida Fink & Joe Kraynak:
» Bipolar Disorder Medication Spotlight: Seroquel (Quetiapine) - Bipolar Beat (December 16, 2008)

From Psych Central's Dr. Candida Fink & Joe Kraynak:
» Bipolar Disorder Medication Spotlight: Geodon (Ziprasidone) - Bipolar Beat (December 19, 2008)

From Psych Central's Dr. Candida Fink & Joe Kraynak:
» Bipolar Disorder Medication Spotlight: Prozac (Fluoxetine) - Bipolar Beat (February 13, 2009)

10 Comments to
“Bipolar Disorder Medication Spotlight: Risperdal (Risperidone)”

I take risperdal and find that it is very effective in managing my symptoms. I take 2mg at nite, in addition to 500mg of depakote and 20 mg of buspar daily. I am finding now that I will probably need to up my dosages as stress and day light savings time are negatively affecting my moods. Risperdal does work great for me as a maintenance med. I gained 15lbs, experience mild sedation in the morning, and have had a slight increase in appetite. Overall it works for me

I was given risperdal for a manic episodes, and i hated it. I had terrible akathisia….the feeling of wanting to jump out of my skin was unbearable. it also dried out my nose and mouth, making breathing really uncomfortable oddly enough, to the point that i had real night terrors for the first time in my life, which i eventually figured out was caused by lack of air in my sleep.
do you know how hard it is to convince doctors of anything while your manic? as good and as well thought out an idea might be, the delivery is a mile a minute with twitching limbs…so when i asked to get off of risperdal, they just said “you’re clearly still manic” and i said “you’re invalidating my education.” BAM so I took an increase in lithium in exchange for no risperdal. i don’t deny that it helped me be less manic…although i would have preferred a slow decent rather than a jarring pull down into a hideous mixed episode.

My Mother has Alzheimer’s. She just started risperidone (.5mg)this week. She has had 4 strokes and resides in a wheelchair. One website stated Do Not Take this drug if you have dementia or are prone to strokes. Has anyone had any experience with risperidone and an Alzheimer’s patient?

i am not a geriatric psychiatrist so I can’t give you too much guidance. I would recommend a thorough discussion with your Mom’s doctor about the choice of Risperidone in her case. Risperidone and medications like it can cause severe problems in individuals with dementia so you want to know what the doctor’s risk/benefit analysis is that she chose this particular drug.

Hi there, I have been on Risperidone since Aug 07 and have had really no issues. Just this past week it was increased to 1mg at bedtime and .5mg in the morning. Now I am starting to see why people gain weight on it since my increase. I see a difference in my mania but honestly the stopping of caffiene has done wonders. Just an FYI if anyone’s interested.

I’m on Lamictal and risperidone. I have a hx of being non compliant. Was just told by my psyciatrist that if I didn’t stay on the treatment plan I would have to get a new provider. I struggle with giving up the mania and am trying to be just a little bi polar. I need to mkake peace with this illness. Especially if my dr. is going to give up on me

My 16 yr old daughter was on 1,000 mg of depakote ER per day, 5 mg Risperdal, 75 mg Trazodone. She was hospitalized less than a month ago with suicidal ideation. The psychiatrist reduced her Risperdal to 2 mg per day over a period of 1 week, then 2 weeks later down to 1 mg per day. 1 week ago she had suicidal ideation and was again hospitalized. The psychiatrist increased her Risperdal to 4mg per day over the course of 1 week. The hospital is wanting to discharge her today and the psychiatrist is again reducing her Risperdal today.

I don’t see how putting her on this rollercoaster of Risperdal dosages is going to possibly help her. Obviously, Risperdal, like Xyprexa and Geodon before it has stopped working for her. I am very frustrated and fear that if she is discharged today without being stable, she will have thoughts of suicide again and may choose a more injurious method and could possible commit suicide. I am at a loss about what to do to get this hospital and psychiatrist to understand that releasing her after playing with her medications like this is not safe and not in her best interest.

Your thoughts?

i have been on seroquel and lemictal and xanax for a really long time, but lost my insurance coverage so i now can not afford the seroquel, so now i will be on the resperdal. does it make it gain weight. and what are the other side effects. it seems i get all the side effects with all mecications.

I am bipolar and have been on Lamictal and it has worked great for me. My son is 6 years old and has bad anger issues. I fear he is bipolar as well. His doctor has him on Risperdal 1mg in the morning and 1mg at night and the stuff doesnt seem to be working. He has been on it a year and the results are very minimal. We have adjusted the doseage and still no change. I heard if a parent is Bipolar that your child has an 80% chance of being so as well…I really think he is and can’t take his medication not working anymore. He is just too hard to handle. I heard Triliptal could work from a friend…Should I suggest this to my son’s psychitrist?

I am taking the generic form of Lamictal and Risperdal. I am also Bipolar.
When I was taking 200 mg of Lamictal, I noticed that I had manic symptoms. I was irritated and easily angered. I was also very anxious and nervous.
Yet Risperdal helps me with the racing thoughts. I was taking 2 mg and had problems with my menstrual cycle. I would take Risperdal every other day and doing this didn’t help. I was supposed to take it every night. I was also sedated in the morning.
So, I now I take 150 mg of Lamictal in the morning and 1 mg of Risperdal and if I need another 1 mg I can take it for racing thoughts also, at night. And my menstrual cycle is back to normal.
I seem to be doing just fine, actually a lot better than before. The side effects are minimal. I don’t have as many as I did before. I’m functioning just fine and feel less anxious, nervous and irritated, etc. And not only because of the medications, there are other things you can do to have a better life and be happier as a bipolar. I have a good diet, go to bed early and most of the time at the same time- being overtired can trigger mania, try to maintain organized and the same schedule and routine, exercise, have support and help- with housework, daughter, etc., continue to see my therapist, assist group, and see my nurse practioner who prescribes my medications, and relax- anxiety can trigger mood episodes, etc. Also, caffeine sould be avoided. Take care.

Ask a Question or Post a Comment:

*
To prove you're a person (not a spam script), type the security word shown in the picture. Click on the picture to hear an audio file of the word.
Click to hear an audio file of the anti-spam word

 


Candida Fink, M.D. and Joe Kraynak are authors of Bipolar Disorder for Dummies. Pick up the book today!
Best of the Web - Blog 2008

Recent Comments
  • Anonymous: I am a 53 year old woman who has tried many of the anti-depressants menioned here for my depression....
  • Becky: I have bipolar with sleep issues. I have been seesawing back and forth between Ambien CR and Lunesta, mostly...
  • N/A: My mom is bipolar and refuses to get treatment. In her manic state she has rage fits that last several hours of...
  • BipolarII?: I have the exact same symptoms that your husband has. I am 27 years old have only recently discovered...
  • Anna: Oh, one more thing - I encourage those who have a loved one with a mental illness to find a support group,...
Article Tools
Bookmark
Print
Email Friend


Stumble It!


Subscribe to Our Weekly Newsletter


Users Online: 1428
Join Us Now!