bipolar disorder, Dr. Paul Markovitz  Q. I am a 32 year old female dx'd with Bipolar Disorder and BPD. I am currently on 500mg Epival in a.m., 225mg Effexor XR in a.m., 1000 mg Epival at bedtime and 2mg Risperdal at bedtime. My past includes 4 overdoses and many times of self injury. I was just released from hospital the other day for the second time this year (2000). I have recurrent problems lately with thoughts, images in my head that won't go away. Have heard a voice before telling me to cut myself (don't know if the voice was my own, or another voice), which I am assuming is why I'm on Risperdal. I still get the images, etc, and the strong urges to cut, (did in hospital too, almost cut myself but they threatened to discharge me if I did). My question is, is the dose of Risperdal high enough, or does it just take a while for it to get into my system. It will be two weeks in two days.

  A. Risperdal is pretty much doing what it will do after a week or so. You might benefit from a higher dosage of Effexor XR. Our paper using the non-XR formulation had an average dose of about 350 mg/day, and people using the XR form need that much, too. Go over your medications with your doctor. Hopefully, they read our paper from 4 years ago.