This entry was posted in Mental Health on March 2, 2012 and modified on April 30, 2019

Many years ago, the only medications available to help people with psychotic symptoms were major tranquilizers, also referred to as neuroleptics. Thorazine is such one drug in this category. For many people, just the word “Thorazine” conjures images of severe mental illness and severe side effects: the shuffling gait and vacant stare among them. This whole category of medications were sometimes called “chemical straightjackets” since their effect was so intense.

Risperdal is the brand name of an atypical antipsychotic – a new class of medication that targets psychotic symptoms but without the intensity of the old neuroleptics like Thorazine or Haldol. It is a fairly new medication, approved for the treatment of schizophrenia in 1993 and pediatric bipolar disorder in 2007.

What is Risperdal Prescribed for?

Risperdal was initially approved for the treatment of schizophrenia in adults, and was later approved for bipolar disorder, schizophrenia, and irritability in children and adolescents. It is a medication with many off label uses, such as: behavior disorders in children, anxiety disorders including obsessive compulsive disorder, some eating disorders, Tourettes syndrome, and some cases of severe depression.

Some clinicians refer to the atypical antipsychotics as “glue” indicating that when thinking becomes “loose” or pro-dromal, psychotic symptoms are present. For example, full blown delusions or hallucinations are denied, but the doctor can tell that these type of thoughts are starting to form. A low dose of Risperdal can help thinking become more rational and thus help prevent emotional outbursts or intense mood episodes.

What Does it Do?

As with most psychotropic medications, the precise answer to how (or why) it works is not known. What is known, however, is that Risperdal is called a serotonin and dopamine “antagonist.” This means that it blocks the action of those two neurotransmitters in the brain. This is seen as positive in cases where serotonin and dopamine activity is associated with psychotic symptoms such as hallucinations or delusions.

What are the Most Common Side Effects?

  • Blood pressure changes (both low and high blood pressure are possible)
  • Weight gain
  • Hormonal changes (and thus possible menstrual cycle changes or sexual dysfunction)
  • Restlessness
  • Insomnia
  • Daytime Drowsiness/Sleepiness
  • Muscle pain and/or stiffness
  • Shakiness, especially in the hands or fingers

While Risperdal does not typically cause the serious side effects associated with the older antipsychotic medications, they could still occur. Tardive dyskinesia (TD) is a very serious and permanent movement disorder that can be quite disfiguring, and is caused by antipsychotic medication. Again, while this side effect is rare, it is important to be aware of it, and to contact your doctor immediately if you notice any extra movements of you facial muscles and/or tongue. Early detection can help minimize the impact of TD.

Special Concerns

Risperdal has become a popular choice for psychiatrists seeking to help parents with children suffering from behavioral disorders: severe irritability, frequent meltdowns and tantrums, aggressive behaviors, etc. This is an “on label” use for Risperdal, and compared to other antipsychotic medications, Risperdal is relatively benign. However, sometimes behavioral management techniques, supportive parenting classes and family therapy may also be effective in reducing these behaviors. Be sure to discuss options with your doctor, as the long term impacts of taking any psychotropic medication can be serious.

Risperdal is one of those medications that you should stop taking gradually. If you plan to switch to another medication or wish to discontinue taking Risperdal, make sure you discuss with your doctor how to handle this safely.

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