Q:  Can Risperdal Have Life Long Effects on my Cognitive Abilities?

I have been diagnosed with bipolar but do not go through the manic stages, maybe except for bursts of energy but not often that.  i am usually depressed and "very" irritable or angry.  I was put on "9mgs" of risperdal for two years and ended up falling in my gpa to a 2.oo.  It has been told to me my cognitive abilities are questionable now along with permanent td.  I don't even know if i was diagnosed in a proper way.  Can this high dose of risperdal have a life long affect on my cognitive abilities.  I am now on lamictal, trileptal, zoloft, and xanax, and requip for the td.  The xanax is the only one that seems  to keep me in a calm mood.  I need help with this because i cannot get any doctors around here to listen to me.  When i started failing in school and blinking really hard along with jaw movement  and clentching my teeth, I asked the dr then to take me off of it and was ignored.  I was just considered  lolly-gaggin around with my school work and basically jus t being a pain. I am now currently off of the risperdal but am still having problems with school, such as not processing what i read and putting two and two together, as well as having a hard time responding to questions, as it takes me a  while to answer.  I have been accussed of not putting forth an effort in counseling and wasting the counselors time because it takes me forever to respond.


Dear K’ --
Considerable research attention is now going into the cognitive impairments experienced by people with bipolar disorder. From that research, it is becoming fairly clear that cognitive impairment is part of the condition itself, not necessarily from medications. However, medications can certainly also cause cognitive impairment  in iety of ways.  Even lamotrigine (Lamictal), which I favor because of its lack of weight gain or other long-term problems, can cause cognitive impairment (particularly at doses higher than 200 mg).  Certainly risperidone can interfere with thinking, although I'm not aware of any evidence implicating it in causing permanent cognitive problems.

Most mood experts generally seem to be operating on the basis of a working theory that keeping symptoms to an absolute minimum is the best way to prevent further cognitive impairment.  The problem is that getting symptoms down to zero, or close to zero, is not easy for many people.

Here is another bit of info that might be useful:  some people with bipolar disorder can experience agitation and irritability (and problems sleeping, which you did not describe, but might be having) not only from the mood disorder itself, but also from antidepressants.  This has been called "acid syndrome" : Antidepressant-induced Chronic Irritable Dysphoria.  So you may need to include on your list of options, as you consider where to go from your current treatment, the idea of tapering off the antidepressant as a means of potentially lowering the irritability and agitation you are experiencing. Do not under any circumstances consider doing this on your own.  This is a very controversial idea.  You can read more about it on my page about Antidepressant Controversies, which has many of the references that should be considered (the whole page is fairly technical; I wrote it as much for doctors as for patients, as a means of summarizing evidence in favor of my views on many of these controversies.  Be aware that the page represents my views, not a consensus among psychiatrists).

If you are working on making sure that communication with your psychiatrist is effective, and a 2-way street.  That's good.  This can take a lot of work.  Some people are in a position to try a different psychiatrist if they can't get that kind of communication.  Others have to work with the person they have as best as possible.  Some thoughts on this challenge can be found on my webpage about Talking with Doctors.

Good luck with the process -

Dr. Phelps



Published January, 2010