Bipolar diagnosis--Starting Lithium

[courtfrog2]

Anyone have any experience? My difficult child who is 9 was just diagnosed with Bipolar a couple days ago. The psychiatrist was very good. He wants me to get into my prim care doctor so that I can get on different medications also because paxil just doesn't seem to be working for me and I also have bipolar symptoms.

Is lithium safe for a 9 year old. He's not starting her on it until she gets her bloodwork back. Any side effects I need to look for. He's keeping her on risperidone for a while too.

Any words of advise for dealing with bipolar and what to look for with the medication treatment?

I'm very nervous.

 

[ML]

I just wanted to welcome you. I don't have experience with lithium but i'm sure others will be along shortly that can help. Hugs, ML

 

[klmno]

Welcome! I just want to clarify, we use "psychiatrist" to mean "psychiatrist". I'm wondering if you meant it to mean a psychologist or other type of professional? I ask because you refer to a dr as prescribing medications, whereas if a psychiatrist were involved, they would typically be prescribing this type of medication.

Also, you want to make sure that you have received as thorough of an evaluation as possible to get the diagnosis before going the bipolar route and completely ruling out other diagnosis's that would be treated entirely differently. So, what types of profs have been involved in diagnosing your child? Has she had neuropsycholgical testing? Has she been evaluated by a child & adolescent certified psychiatrist who also reviewed the testing results? Although there is no "test" for bipolar, the testing can rule out other diagnosis's, find comorbid disorders, reveal deficits in areas that are common for bipolar, and reveal difficulties in areas that need supports at school.

If you are comfortable with the bipolar diagnosis, lithium is a fine place to start, at least with older kids. My only question would be is it safe for a child that young and I'm really not sure. It would probably be ok after blood tests are done, but of course, I'm not a dr.

Here are links to web sites that I have found very useful:

http://www.dbsalliance.org/

http://www.jbrf.org/

There are many books about kids with bipolar- others can recommend what they have found most useful.

Again, welcome!! The medication battle can be long and strenuous sometimes, but lithium, along with a few others (lamictal for instance) is tried and true in the world of BiPolar (BP), but I tend to hear about anti-pshotics (AP's) being used instead of them in younger children a lot. But, as I suggested before, honing in on the diagnosis as much as possible and YOU being comfortable with it is a big first step. Also, I'd start the IEP process now if you haven't done this already.

 

[courtfrog2]

Oooh... should have clarified. My daughter has been having issues for a while. She went to a psychiatrist (psychiatrist) back in October who wasn't very good. Said she had depression... didn't listen to us etc... and put her on Zoloft. Had a major manic episode after he raised her dose and she was hospitalized in December. She was put on risperdal, which has shown some improvement but she is very worried all the time. The psychiatrist at the hospital said she has a mood disorder not otherwise specified, ODD, and anxiety.

I found a board certified child and adolescent psychiatrist for her and we went to see him a couple days ago. He did alot of questioning, evaluating, spend an hour with us. Talked about our family history (Which is why he wants me to go get into my doctor to see about treating me for a mood disorder instead of just the depression since I have had manic phases in the past... I'm on paxil and it doesn't help very good).

He explained bipolar and she fits it to the dot. Even prior to medications. ADHD doesn't seem to fit her since she does fine at school and is very advanced. I'm actually confident of the bipolar diax given our family history of it (my cousin is bipolar and my sister is borderline personality disorder officially diax). My mom has very high swings too.

My difficult child has had trouble since she was born. She's the one that the psychiatrist evaluated. He sees her again in 2 weeks after her bloodwork gets sorted out.

Anyone have experience with lithium in a 9 year old?

 

[courtfrog2]

Isn't IEP dealing with school? She actually is not doing terrible in school... yet.

 

[Sagegrad]

My 8 yo is on Lithium. We used it very successfully about a year ago then for various reasons took her off it. She is now back on and we are working at getting her to a therapeutic level. We were very happy with the results a year ago and really hope we can duplicate them this time.

Sage

 

[klmno]

Smallworld knows a lot about medications- maybe she'll pop in later. Also, there may be others around who can offer some experience about lithium for a 9yo. My son takes it and it helps him a lot but he didn't get a BiPolar (BP) diagnosis until he was 12yo. Keep in mind, these types of medications work very differently in different people, but I take it you just want to make sure it's safe to trial it, and I don't blame you. If you don't get any others' experience, I would go with what the psychiatrist said as long as I was comfortable with the psychiatrist.

My son does better (less side effects ) on lithobid, which is extended release (or time release-not sure) version of lithium carbonate. Most common side effects are increase in thirst and then needing to urinate often. This decreased in my son after many months. He had stomach upset at initial introduction and at each increase in dose. This went away after a few days except his last increase while titrating up, which then psychiatrist switched him to lithobid and now he has little or no side effects. His hands do get very jittery sometimes- it didn't start until after starting lithium, however, it also runs in my family. It happens mostly when he has skipped a meal and goes away after eating. Of couorse, blood levels have to be monitored.

http://www.rxlist.com/eskalith-drug.htm

This is a pretty good link about describing medications- click thru different pages for lithium (eskalith) and it should tell you about use in children.

Re IEP- yes that's for school. If she's had neuropsychologist testing, it might have revealed excutive functioning deficits, memory, etc., not pertaining to traditional ideas of a learning disability. She might be too young for these to be causing a difficulty at school yet. Then, BiPolar (BP) can effect behavior at school and medications might have side effects (ie, cognitive dulling, the needs to carry a water bottle all day) that will require her to have some supports at school. These all need to be documented and provided thru an IEP. If it isn't a problem now, keep a watchful eye so you can get her an IEP as soon as possible. It will protect her rights and provide her with accommodations that will become more and more important.

Good luck!!

 

[butterflydreams]

I am surprised they are going the lithium route without trying other medications first. Lithium is good, but it is a very heavy duty medication. Our psychiatrist exhausted all other medications in the atypical range first and then he said ok, those haven't been working we need to look at the harder stuff. This is the order we will work with:

1. try depakote, if it doesn't work,
2. try Lithium, if it doesn't work,
3. try tegritol

He said that is the order that we would try the heavy duty medications. Currently we are trialing depakote.

 

[klmno]

You need to watch out using depakote on a female- there are risks there that don't exists with depakote use in boys, I believe.

Also, I forgot to mention, many medications for BiPolar (BP) can cause a lot of weight gain- increased apetite.

 

[bran155]

Hello and welcome.

I tend to agree with butterflydreams. My daughter did not try Lithium until her mid teens. She did everything, and I mean everything else first. While we did see results when she was on the Lithium, I too am of the understanding that it is a very heavy duty medication. I am surprised to see that such young children take it. I am no doctor by any means though. In any event, do the research, look for side effects. My daughter did have lock jaw and a few of the other possible side effects. She had to take Cogentin to counteract the side effects. Just be cautious and educate yourself so you know what to watch out for.

Good luck and God bless.

 

[bran155]

klmno, you are right about the Depakote, it can cause cysts on the ovaries. My daughter took it for quite some time and had no problems but that is a possible side effect.

 

[TerryJ2]

Hi Courtfrog, nice to meet you.

I see that you're already getting some good responses here, which makes me feel good because I have had no personal experience with-kids and lithium.

Just wanted to lend support. I hope things will improve soon.

 

[gcvmom]

No experience with lithium, but wanted to welcome you!

My difficult child 2 has taken Risperdal in the past and it worked very well for a while in managing his impulsive aggression and emotional swings. He now takes Seroquel XR is for the most part stable.

I understand with lithium there are frequent blood draws to monitor levels, so hopefully that won't be a problem for your difficult child. It's supposed to be the gold standard still in treating BiPolar (BP), and it is being found to have neuroprotective/regenerative properties for other brain disorders.

 

[compassion]

Welcome!!! My difficult child was diagnosis BiPolar (BP) in late July,2008. Abilify (antipsycotic 15 MG. AM) and mood stabilizers 100 Lactimal PM. A lot of weight gain but seh is also on Deprovera. These seem to be state of the art newer type treatments. I have read a lot about BiPolar (BP) in children and adolsecents and it takes a very long time for stabilizstion. Acute phase is like 3-4 months, then mid pahse and then manitance. It takes a lot of patience. Compassion

 

[Jena]

hi and welcome. Im glad that you are comfortable with the diagnosis that was given. We use seroquel, she is better on it. Yet we have extreme weight gain and some tics. Seroquel combats the anxiety very well for us, which my difficult child has bigtime.

I've heard wonder stories about lithium with certain children. Does your difficult child have sleep issues?? like up for a certain amt of days that sort of thing than crashes

 

[Wiped Out]

Adding in my welcome. My difficult child was on lithium at one point (age 7 or 8). For him it was a no go and he had side effects. He was always extremely thirsty and went back to wetting the bed. However, that was him, I've heard great things about it for others.

 

[courtfrog2]

She usually doesn't have sleeping issues now. She is constantly scared now at bedtime. I have to lay with her... but when I do she falls asleep in a matter of 10 minutes or so then I get up.

 

[jcox]

My son who is six began Lithium about a month ago. We have noticed that his moods have stabilized somewhat on it already. He shows less agression, less hyperness, and more overall baseline moods than he did before it. He is able to stay on one topic and hold conversations without his brain racing so much. He needs to get bloodwork done to check his levels. They said we need to be careful to watch him for diarrhea, vomitting, or trembling because those are signs of toxicity. From all I read about Lithium it says that the therapeutic level is very close to the toxic level. So far he has not had any signs of those things and his psychiatrist recently raised up his dosage again. We have to get the bloodwork done and then it might be raised again. They started him on the lowest dose. Now he is on 300 mg twice a day.

 

[BusynMember]

Actually there are no "safe" BiPolar (BP) medications. Lithium has been around a long time and more is known about it than the newer medications. Antipsychotics, which are more readily prescribed, in my opinion have more side effects than Lithium, a drug I took. Depakote was horrible for my kids. Very heavy side effects for both. Trileptal didnt work. I have taken Tegretal and I hated it--I felt like a completely doped zombie (doesn't mean it will do this to everyone). These are ALL heavy duty medications, but Lithium is more known. I hear Lamictal has less side effects, but I'm not sure. My son takes it and likes it.

 

[crazymama30]

medications work differently for everyone. For some kids here Lamictal was a life saver, for others it is horrible. Unfortunately there is no way to tell what will work and won't work. There may be links between 1st degree relatives (mom and dtr, mom and son) and what works, but that is just what I have heard and observed with my husband and difficult child.