My dad is having a bipolar disorder mania and he is in high state and

My dad is having a bipolar disorder mania and he is in high state and we feel that he is not well from past 20-25 days and we consulted around 20-25 days back to the doctor and he gave this prescription. I personally think that this prescription is not right and the medicines are not working as intended and you know it's been already 20-25 days and like it's been 20 days almost and still he is not recovered completely. So what are your thoughts about this? Should we change the doctor? What do you think about the doctor and the medicines that he has prescribed? He has prescribed. I mean we see a little bit of difference, a little bit of recovery but that is very slow we feel and he is still not recovered completely.

Reading File

Finding Sources

Searching the Web

bipolar mania treatment response time lithium valproate risperidone weeks to recover

Finding Sources

Searching the Web

Dayuigo 10mg medication bipolar sleep mania India brand name

Now I have everything I need. Here is a thorough, evidence-based breakdown:

Analysis of Your Father's Prescription & Recovery Timeline

Patient: Arun Agrawal, 52 years, Male Prescribing doctor: Dr. Yami Khandwala, M.D. Psychiatry — Healthy Mind Hospital, Ahmedabad Date of prescription: 6 May 2026 (follow-up in 15 days)

The Medications Prescribed

Drug	Dose & Timing	Purpose
Divaa OD (Divalproex/Valproate ER)	750 mg — once at night	Primary mood stabilizer for acute mania
Intalith CR (Lithium carbonate CR)	450 mg — once in morning	Second mood stabilizer / antimanic
Risperidone MT	1 mg — once at night	Atypical antipsychotic for acute mania
Dayvigo (Lemborexant)	10 mg — once at night	Orexin antagonist for insomnia/sleep

The blood levels from 5th May are also noted: Serum Lithium 0.5k ≈ 900 mg, Serum Valproic Acid 86.7 ≈ 1500 mg — meaning the doctor was monitoring and adjusting doses based on labs, which is a sign of careful management.

Is This a Good Prescription? Yes — It Is Evidence-Based.

This is a standard, guideline-concordant combination for moderate-to-severe acute mania:

Divalproex (Divaa OD) + Lithium (Intalith CR) — Combining two mood stabilizers is recommended by international guidelines (Maudsley, CANMAT, BAP) for severe or inadequately responding mania. The doctor has clearly been monitoring blood levels and titrating doses accordingly, which reflects good clinical practice.
Risperidone 1 mg at night — Risperidone is FDA-approved and widely recommended for acute bipolar mania. Studies show onset of antimanic effect within the first 1–2 weeks, though 1 mg is a relatively low dose for mania (standard range is 2–6 mg/day). The doctor may be keeping it low because he's already using two mood stabilizers.
Dayvigo (Lemborexant) 10 mg — Sleep disruption is a hallmark and perpetuator of mania. This is a modern orexin-receptor antagonist for insomnia — a thoughtful addition to ensure sleep, which itself helps break the manic episode.

Why Hasn't He Fully Recovered in 20–25 Days?

This is the most important part. Incomplete recovery at 20–25 days is not unusual and does not mean the prescription is wrong. Here is what the evidence says:

Lithium: Full mood-stabilizing effect in acute mania typically becomes apparent after 10–14 days, and sometimes up to 3 weeks. The pharmacodynamic effect has a known delay. — Harrison's Principles of Internal Medicine 22E
Valproate (Divalproex): In a comparative study, median time to remission with divalproex was 62 days vs. 14 days with olanzapine. It works, but it is slower. — Kaplan & Sadock's Comprehensive Textbook of Psychiatry
Risperidone: Significant improvement typically seen within 2–3 weeks, but at 1 mg — a low dose — the effect may be partial.
In general: For moderate-to-severe acute mania, most clinical trials measure outcomes at 3–6 weeks. Even with optimal treatment, 40–80% of patients show "at least moderate improvement" in 2–3 weeks — not full remission.

So seeing "a little bit of recovery" at 20–25 days is within the expected clinical range, not a treatment failure.

What Should You Actually Be Concerned About?

A few things are worth raising at your upcoming follow-up:

Risperidone dose may be low. At 1 mg/night for a 52-year-old in acute mania, this is conservative. Clinical guidelines suggest 2–6 mg/day. If recovery remains slow, the doctor may increase this.
Serum Lithium of ~0.5 mEq/L is at the lower end. The therapeutic range for acute mania treatment is 0.8–1.2 mEq/L. The note says "0.5k ≈ 900 mg" — this may mean the level was low and the doctor was adjusting. This is exactly why blood tests matter.
Valproate level 86.7 µg/mL is within the standard therapeutic range (50–100 µg/mL), so that appears appropriate.
The 15-day follow-up is appropriate. The doctor scheduled a review in 15 days — this is standard practice for an acute manic episode.

Should You Change the Doctor?

No — not based on what you've described. In fact, the evidence suggests this doctor is doing several things correctly:

Monitoring blood levels (lithium, valproate) — many doctors skip this
Combining mood stabilizers appropriately for a severe episode
Including a sleep agent (very important in mania)
Scheduling timely follow-up
Adding an antipsychotic for faster symptom control

The "slow recovery" is pharmacologically expected with this regimen, especially with divalproex. The follow-up in 15 days (which may be around 20 May) is the right moment to discuss with the doctor whether to increase the risperidone dose or make any adjustment.

What You Should Do Right Now

Do keep the follow-up appointment as scheduled (~15 days from 6 May = around 20–21 May).
Track specific symptoms between now and then: sleep hours, speech rate, activity level, irritability, judgment — so you can give the doctor concrete information.
Do not stop or change doses on your own. Abruptly stopping lithium or valproate can cause rebound severe mania.
If his condition worsens significantly (aggression, self-harm risk, not sleeping at all, psychosis), go to the doctor or ER before the scheduled follow-up — do not wait.
Ask the doctor specifically: "Is the lithium level now in the therapeutic range? Should risperidone be increased given the slow response?"

This information is based on Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Harrison's Principles of Internal Medicine 22E, and The Maudsley Prescribing Guidelines in Psychiatry, 15th Ed. It is for informational purposes only and does not replace your treating psychiatrist's clinical judgment, who has directly examined your father.

This is a shared conversation. Sign in to Orris to start your own chat.