Q. I just started taking Risperdal. What actually does it do to the brain? What physically does it do? Can it help with memory? Will the sleepiness get less? Is it a short term medication or one you can take a long time?

A. Risperdal is an antipsychotic, and comes from a newer group of antipsychotics referred to as atypicals. The typical or older antipsychotics worked by effectively lowering the chemical dopamine in your brain. The newer atypicals do this too, but also work on serotonin. There are very few trials of atypicals in BPD. If it helps, that would be great. The sleepiness will diminish some, but likely never go away. You can probably take these agents for as long as your doctor feels appropriate.

We have done a study using Serzone, which works on serotonin the same way as atypicals without the dopamine effects, and many patients did very well. If sedation and mental slowing are a problem, you might ask your doctor about trying Serzone as 500 to 600 mg at bedtime.