Hi Dr. Phelps,

I basically have 2 questions.  But first a little background.

Meds:  depakote 1000 mg (perhaps to be raised - don't want to get too sleepy)

      risperdal .25 mg (on a month now)

      prozac     5 mg (yes, I know a baby dose)

      klonopin   l.5 mg (soon to be lowered, hopefully)

      topamax    12.6  (recently discontinued any higher, went manic and had awful menstrual cramps)

This mix is super!  Knock on wood of course.  The addition of risperdal has been a Godsend.

Now for the questions regarding risperdal:

1.  what are my risks for tardive dyskensia (spelling?) on this dosage?  and

2.  I have a family history of breast cancer and should I be especially concerned (it does cause a bit of soreness in breasts)?  I'm 50 and female.

I know there are other anti-psychotics out there, but I don't like their profiles (sleepiness, weight gain, etc., and I hear geodon is a loose cannon - I go manic quite easily).

I'd appreciate your opinions on my questions.  My pdoc says there are always risks, but I'd like to know what your views are since you are always on top of the latest information.

Thank you in advance for your thoughts on this matter.

Your biggest fan,
Maggie (BP2, OCD, GAD, and a plethora of other letters I could add... LOL!!

Dear Ms. Maggie -- 
Never thought of having fans, FOF (flush on face).  Anyway, here goes: first, re: tardive dyskinesia -- so far it looks as though the "new generation" antipsychotics have dramatically less TD risk, and it's so low it's a little hard to know yet just how much risk there is.  It appears there is some risk all right, but it looks very low (whatever that phrase means when you get right down to it) -- especially at the dose you're using right now.  For example, TD has been associated with so-called "EPS" (extrapyramidal symptoms, meaning in the involuntary, not the voluntary or "pyramidal" system -- named after the cell shape).  That is, people who get EPS, like muscle stiffness, from their antipsychotics are more likely to later get TD.  And risperidone can cause EPS too, though less than the old ones, and generally it takes doses of 2 mg at least, more commonly 4-6mg, to get that side effect on risperidone.  So, at least "by extension", the risk of TD on risperidone is  probably a lot lower when the dose is lower (and we know that's true for the old-generation AP's). 

As for breast cancer, my limited understanding is that increased risk from risperidone would be through "prolonged unopposed estrogen" if a woman stops cycling because of the increase in prolactin that this medication can cause.  The point is I'm not aware of an implication of breast cancer risk if you're not cycling at all (done yet, yourself?).  However, your doctor might know something I haven't heard yet on this subject ( a quick literature search using "antipsychotic breast cancer" showed only articles relating to prolactin increases as a concern; "risperidone breast cancer" returned no articles).  

Dr. Phelps