Risperdal/Seroquel Combo as a Mood Stabilizer?
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Q:  Risperdal/Seroquel Combo as a Mood Stabilizer?

Dear Dr. Phelps,

My 10 1/2 yr. old daughter is dx'd with many disorders. Adhd, OCD, ODD, Tourettes, PTSD and lastely Bipolar type 1 this past January. Her psych. doc had her on 50mgs of Starrera, 3 1/2mgs. of Risperdal and 150mgs. of Seroquel per day.

She has never been stable and was/is becoming worse. I had found a support message board for parents of bp kids and many of them told me of the possible effects of the Strattera causing manic in bp kids. I called her pdoc and asked about the possability of the Strattera causing the manic after a extreme manic episode. He said to take her off the Strattera and upped the dosage of the Seroquel to 250mgs. He also mentioned wanting to talk to me about putting her on Wellbutrin in place of the Strattera at her next visit. I asked why she was not on a "mood stabilizer" he stated that he was using the Risperdal/Seroquel combo as her mood stabelizer.

Many of the parents on the message board have questioned this method and said they have never heard of 2 antipsychotics being used as a mood stabilizer. The boards administrator told me I should write you and ask about this method and about adding the Wellbutrin to an already unstable child.

What do you think?

Thanks for your time.

Dear Shelly --
Well, sounds like you're not really trusting this doctor. Maybe time for a 2nd opinion? Or, if that's not possible due to things like distance or $, you may have to figure out a way to work with her to have more of a "team approach" than you've got going now. In that case, I hope you might find something useful in my little essay on talking with doctors.

To answer your question, I'm glad to hear the kind of feedback you're getting from the other sources you named. It means that there is a sort of an emerging "group think" out there that matches the expert consensus opinion approaches (see my brief review of those consensus opinions on my mood stabilizer list page). I agree that Risperdal/Seroquel does not constitute a "mood stabilizer" in the sense that the expert consensus guidelines imply. Mind you, it's not exactly clear what a "mood stabilizer" is, or rather, how that category ought to be defined. See a few more thoughts on that in my blurb about Risperidone/Seroquel/cousins.

Dr. Phelps

Published January, 2004


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