Risperidone

A reader asked:

My son was diagnosed with bipolar disorder.  Does medication like risperidone act quickly? My son, who also has autism, is experiencing rapid speech, pacing, repeated questions about his anxiety, even though he has been on his medication without interruption. We have increased it and  do not see a change. What kind of interventions are available for quicker relief of mood symptoms?

Dr. Dave:

Generally, risperidone leads to symptom relief in an average of 4-6 weeks, but the timing is variable, and depends on the diagnosis, illness severity, age, and other medications that are prescribed.  A good resource for info about risperidone in kids is:

https://www.youngminds.org.uk/young-person/medications/risperidone/

For a kid with autism and bipolar I disorder, first I'd recommend getting a full diagnostic workup to make sure he really has both disorders.  Sometimes kids get both diagnoses beacuse they have anger outbursts and/or instability of mood, which is not the same as bipolar disorder.  Kids with autism often have anger meltodwns when routines change or some expectation they have is not met - a lack of flexibility, in other words. Anger outbursts do not constitute mania unless there are other associated signs like decreased need for sleep, rapid thinking, increased energy, grandiose thinking, and ongoing irritability/and or elevated mood.

You should meet with his psychiatrist to discuss the lack of benefit - it may be too soon, or the dosage may not be right, but the doctor should be given a chance to reevaluate the regimen to see if it's right for him.  The doctor may recommend other second generation antipsychotics (e.g., Geodon, Abilify) or mood stabilizers like lithium and lamotrigine. Finally, I'd suggest getting your son some behavioral therapy if he doesn't have it already - it can help with teaching him to regulate his emotions and to manage his anxiety.

Best wishes.