another medication bites the dust

Discussion in 'General Parenting' started by pepperidge, Jun 28, 2008.

  1. pepperidge

    pepperidge New Member

    HI

    Just wanted to report on the latest medication trial for difficult child #2 who has Fetal Alcohol Effects (FAE), and is quite impulsive, distractable, and very inflexible when he doesn't get his way. Doesn't really fit the childhood bipolar diagnosis very well, closest thing seems to be what Smallworld talked about a while back of severe mood dysregulation. After trying Ritalin, Focalin, Adderall, Welbutrin, Topamax, Trileptal, Lamictal, Tenex, Strattera and who knows what else, to no to bad results we are down to Abilify which has worked from the get go to curb impulsiveness a bit. But we can't go any higher than 2.5 mg cause it causes tics.

    With extremely much trepidation we finally decided to try Zoloft. We have titrated up pretty slowly.

    Felt we were getting some less perseveration --fixation with things (like going shopping at midnight), then went up in half steps to 50 mg in the last week or so. Well this past couple of weeks we have seen shaving of the eyebrows, inhaling helium at a friends birthday party from balloons (after being told not to do it) and crashing our little farm tractor (not serious) without getting permission to ride it, to parading around in my underwear tonight, funny but not really appropriate in a boy going through puberty.

    I've come to the conclusion that this is disinhibition. My older son (who is more classic mood disorder) flipped out early on a too high dose of Lexapro from a very inexperienced child psychiatrist--we learned quick after that one.

    So we will start titrating back down (more quickly!) and talk to the psychiatrist next week.

    anyway, I hope it is the Zoloft because the impulsiveness has gotten a lot worse, but am kind of bummed out because it did seem to be helping a bit with the door slamming, inability to let go of perceived slights , bad mood type behavior anytime we didn't go along with difficult child's program.

    medications have made such a big difference for our oldest son, but this one, not much seems to help. Perhaps to be expected with a kid with Fetal Alcohol Effects (FAE). I am so worried about the next few years because of the impulsiveness and absence of forward thinking. I am beginning to think that he can only be somewhere where there is close adult supervision. You know how that is going to fly in the teenage years with a kid who in many ways isn't so far out of the normal range.

    Feeling down.
    Pepperidge
     
  2. Andy

    Andy Active Member

    Pepperidge, I am sorry this is happening. I hope you find answers soon - deadends can get wearing. I'm sure it is just as frustrating for difficult child 2.
     
  3. susiestar

    susiestar Roll With It

    I am sorry.

    hugs, Susie
     
  4. Steely

    Steely Active Member

    So sorry. I have been there done that.

    What about trying the classification of medications called mood stabilizers? All of the other medications you mentioned are in the class of stims, and anti-depressants. Sounds like he needs a medication targeted to address his mood instability.
     
  5. Sara PA

    Sara PA New Member

    Topamax, Trileptal and Lamictal were all mentioned. The last two are mood stabilizers and Topamax is pretty much considered to be one. That brings up the "how much?", "how long?" and "what other drugs were on board when they were tried" questions.

    But if it's Fetal Alcohol Effects (FAE), it simply may not respond to medication.
     
  6. ML

    ML Guest

    I am sorry you're feeling down. Don't give up hope. You've been able to eliminate a lot of what doesn't work so that means you are closer to finding out what "does". And I know you will because you never give up. Your son will benefit from your perserverence and love. Hugs, ML
     
  7. pepperidge

    pepperidge New Member

    thanks for the kind words. I am just about to give up on the medications for him.

    When we did medication trials, we always did one at a time. Most had pretty immediate negative impacts (Stims, tenex), other very little impact. I think we got up to 200 mg of Lamictal with no positive impact (for my oldest we began seeing positive benefits at 25-50 mg), Trileptal was up to 1200 mg, and Topamax just zoned him out even at 75 mg. I think. You would think he would respond positive to MS, but it just hasn't been the case.

    Wonder if any of you have had Fetal Alcohol Syndrome (FAS) kids with difficulties medicating them?
     
  8. timer lady

    timer lady Queen of Hearts

    pepperidge,

    We are currently having wm (who has incredible impulse control issues) assessed for sensory issues. His last neuropysch came "this" close to diagnosis'ing him with sensory integration disorder but didn't.

    Now we are readdressing the sensory issues we know that wm has with the thought that he has no mind/body connection, if you will. There is no doubt that wm will be diagnosis's with Sensory Integration Disorder (SID) at this clinic that specializes in Sensory Integration Disorder (SID) & we will be starting intensive Occupational Therapist (OT).

    Over the years, even with-o the diagnosis, I've used many sensory items & rituals with the tweedles for calming & impulse issues.

    Have you looked into possible sensory issues - especially given the Fetal Alcohol Effects (FAE)?


     
  9. crazymama30

    crazymama30 Active Member

    I am sorry you are having problems and hope that things get better soon. I wish I knew of something that will help you and difficult child.
     
  10. totoro

    totoro Mom? What's a GFG?

    Yes sad pretty much fits it, huh? You just want something to work. We are on Depakote and Seroquel right now. psychiatrist thinks the Depakote may not be the one... we are giving it some more time.
    We had the some problem with Abilify.
    We use the sensory tools as well.
    I have started reading, Dr. Mani Pavuluri's new book I can't think of the title. You can google it. But she starts of with actually suggestions on what works how to work and live with kids with Mood Disorders. I think she is going to have some good ideas. She firmly believes medications and whole family adjustments, cognitive therapies. She has all kinds of tools and ideas.
    Just an idea.
    Hang in there.
     
  11. TerryJ2

    TerryJ2 Well-Known Member

    Hmphf. I replied to this and it disappeared.

    At any rate, I am so sorry that it didn't work and he's had other symptoms. How frustrating.
    You've gotten some good ideas here.
     
  12. smallworld

    smallworld Moderator

    Hi pepperidge, I'm sorry things didn't work out with Zoloft. If you had stayed with a lower dose (before you hit 50 mg), were things acceptable or did you still feel he needed more medication to address his issues?

    I'm going to recommend something unconventional. Because your difficult child exhibited disinhibition rather than mania, you might want to try another AD. According to Dr. Daniel Pine at NIMH, disinhibition is a side effect, not an indication of bipolarity. He recommends trying two SSRIs before ruling out the whole class. Both Celexa and Lexapro are supposed to be "softer" SSRIs than Zoloft or Prozac, which can be stimulating. If you don't feel comfortable trialing another SSRI -- we didn't with M because she became disinhibited on Prozac and her siblings had already had manic reactions to just about every SSRI out there -- you might want to consider an AD in a different class, such as a tricylic or Remeron, which is in a class of its own. M has not become disinhibited on Remeron, although it's still not addressing all of her issues so we may be heading toward a mood stabilizer at some point.

    In addition, has your difficult child ever tried Seroquel? Our neuro says it is a "softer" AP than some of the others. It also addresses anxiety at relatively low doses -- 25 mg to 200 mg. J had terrible akathisia and dystonia on Risperdal, but has been able to tolerate high doses of Seroquel (up to 800 mg) with zero side effects (save sedation).

    Good luck. I know this is frustrating. What is recommended in terms of interventions for kids with Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE)?
     
  13. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I can totally relate to the medication merry-go-round. difficult child has trialed 17 or more medications. Some have helped more than others. I hope you find some relief soon. Hugs.
     
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