Dear Pamela:

That sounds terrible, I can certainly identify and my heart goes out to you. I'm a little unclear on the current pharmacology. Recently discontinued Risperidone? Still on Lamictal / Ritalin?

I'm not an m.d., so I certainly can't provide 'advice' on the matter. What I can suggest, based on personal experience and accounts I've read are a couple of possibilities that might account for the present symptoms: explosive anger / impulse control, insomnia.

The antipsychotic risperidone can & does often seem to induce rapid cycling in cocktails that include ADHD medication or antidepressants. & all alone, it can produce impulsive behavior.

Withdrawal from risperidone alone can result in psychosis, that's probably been curbed by the lamictal, but plenty of reason to guess that the risperidone withdrawal is part of the problem. About a month ago? If so, that timeline sounds pretty familiar.

Complicating the issue is the concurrent (?) use of ritalin, which as you know is an amphetamine derivative, which could certainly produce something that looks very much like the situation you're describing.

I don't have a solution for you Pamela, but please consider the possibility that the symptoms result from a combination of the stimulant ritalin and the withdrawal factor of risperidone. If either of those apply, I'm not at all surprised by your account.

All things considered, I think you're currently handling the situation beautifully! You're calmly considering the repercussions of the evening, and you're taking responsibility for the outburst. That's not the same as obsessive guilt, which you certainly oughtn't feel, and should try not to. Don't beat yourself up over this.

Again--not a doc, but if I've understood what you've described, it seems to have 'bad cocktail' written all over it. Do you feel comfortable discussing the symptoms with your doc / asking whether the current drugs might have played a part? If not, it might be time to seek another psychiatrist.