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)
- Disorganized thinking
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:
- Elevated mood
- 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.