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On ativan, risperdal and stilnox for bipolar disorder. Behaving aggressively. Side effect?

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Practicing since : 2004
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A friend of my is on Cipralex, Epilum, Urbanol and Stilnox. He recently was taken off the Urbanol (after being on it for a year). He was now put onto Ativan and Risperdal as well. Is this normal medication for bipolar disease?
He recently became very aggresive. Could this be a result of the meds?

Posted Tue, 1 Jan 2013 in Bipolar Disorder
Answered by Dr. Ashish Mittal 10 hours later
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     36 year old male
•     Known case of Bipolar disorder
•     Currently on: Cipralex, Epilum, Ativan, Risperdal and Stilnox
•     Complaints of: Aggresive behavior.

In Bipolar disorder patient has both manic and depression episode. In depression most common symptoms are: low mood, decrease energy and negative thinking. In contrast, in Manic episode common symptoms are: over cheerfulness, anger, irritability, increase energy and decrease need for sleep.

Following medicines are well researched and found to effective for Bipolar disorder: Lithium, Depakote/Epilum (Valproate), Lamictal (Lamotrigine) and Carbamazepine. These medicines also called as mood stabilisers and given for for long term to stabilise mood. They prevent both depressive and manic episode. Even if patient become ill while on medicine, illness is less severe and last for short period.

Out of these medicines patients got stabilised on one or combination of two medicines. Choice of medicine is depend on patient illness state (which can be assessed on interview only), side effect profile of medicine, and duration of illness, weight, age and sex of the patient. Sometime other antimanic agent (like Risperidal) needs to be added depending on the severity of episode and anti depressants (Cipralex) need to be added during depressive episode..

Ativan and stilnox is given to decrease anxiety and to help in sleep.

If your friend is becoming aggressive then there is need to rule out manic episode after mental status examination by psychiatrist. If he has manic episode then his cipralex which is an antidepressant, may need to be stopped. So, it is advisable to visit psychiatrist due to current change in behavior of your friend.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Dr Ashish XXXXXXX Mittal
Above answer was peer-reviewed by
Follow-up: On ativan, risperdal and stilnox for bipolar disorder. Behaving aggressively. Side effect? 9 minutes later
can this disorder really be so severe that he can have a complete change in personality
Answered by Dr. Ashish Mittal 23 minutes later
Hello again,
Thanks for follow up.

Yes, During episode of depression or Mania personality may appear changed temporally.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Above answer was peer-reviewed by
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