Use of Risperidal
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 Use of Risperidal 

Q: I have successfully managed my symptoms for several years on a combination of lithium, Serzone, klonopin, and an occasional flurazepam. In the last few weeks there has been a tremendous increase in stress at home and work in additiona to having to see a new psychiatrist. During my most recent visit with this new psychiatrist I was certainly agitated and had not been sleeping for several days. His recommendation was to add Risperidal to my med cocktail to alleviate some of the anxiety and agitiation. This seemed like a rather drastic measure to 1) add yet another medicine, and 2) add a newer antipsychotic. I am curious, is the use of Risperidal in situations like this is common for persons with bipolar disorder? 

Dear Amanda -- Common, hard to say: nobody really has a good handle on what's common in a circumstance like this, i.e. what do other doc's do? Good idea? No clear evidence it's a bad idea. For a while there was a real concern that risperidone had the capacity to induce manic symptoms. I'm still quite convinced that happens, we just don't really know how often, and some recent studies (although sponsored by Janssen, the manufacturer) did not show a pro-manic effect of risperidone at all (e.g search "risperidone bipolar" and look at recent stuff). It looks like a good stabilizer for some people, though we don't have a good long-term feel for that. Alternatives include: more meds for sleep (Ambien, Ativan, or more flurazepam), more mood stabilizers, less Serzone (a teeny reduction). All have their potential problems. Some obvious but difficult non-medication steps include stress reduction somehow, more exercise, watching your daily schedule and trying to stick to something regular. In any case, review your options with your provider.

Dr Phelps

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