Bipolar disorder in teens

[maril]

Over time, I have learned about bipolar disorder and understand it is difficult to diagnose in children and teens. I have a family history and my 17-year-old difficult child has some symptoms of it, and he has been assumed to have ADHD (based on evaluations and testing in school two separate occasions in about the past four years/currently is treated with a stimulant and has had other interventions). difficult child has never been ruled out for bipolar, as far as I can tell.

I have mentioned my concerns to his psychiatrist in the past, but she didn't say that bipolar disorder might be a possibility. He was in to see her a little over a week ago, and due to depressive symptoms, she increased his generic Zoloft from 50 mg to 100 mg (he is still only taking 50 mg along with his Vyvanse 30 mg early in the morning).

Earlier tonight, he was very upset (had a fight with his girlfriend) and was talking about hurting himself. I talked with him and asked him if he thinks we would need to get some help tonight to please let me take him to the hospital. He seems to be okay now.

My husband just left for work not so long ago and asked me to keep an eye on difficult child (goes without being said).

I worry about difficult child taking the medications I mentioned, if there would be any chance that he could have bipolar disorder. I will call his psychiatrist tomorrow to see what she says.

 

[susiestar]

HI. You are quite right to worry about his medications. The Academy of docs who certify child adn adolescent psychiatrists (I forget the name, but someone will know hte official name) has a protocol for treating bipolar.

It calls for stabilizing the mood with 1 or even 2 first-line mood stabilizers, and THEN addressing any ADHD or other problems.

Stimulants and antidepressants can BOTH cause someone with bipolar to cycle. Until the cycling is stabilized the person really cannot function at their best. And sometimes not at all.

Stimulants can also cause aggression.

Zoloft can cause depression and aggression. My son was fine for about 2 months on zoloft. By month 4 he was dangerous, MOSTLY because this medicine. It seems to do that more in boys, based on anecdotal evidence from other parents.

With both stimulants and aoloft in his system, your sons moods CAN'T stabilize. He needs a medication wash and THEN a trial of mood stabilizers and other medications to treat the bipolar.

I hope the info is helpful and I will keep good thoughts for your son that he doesn't hurt himself or anyone else. Signs like wanting to kill himself right after an increase in Zoloft are HUGE HUGE HUGE red flags that he needs to be OFF that medication. It is part of the FDA warning in the black box on the package.

Good luck with the psychiatrist tomorrow!

 

[LittleDudesMom]

Marilynne,

I think you are right on the mark to be concerned. If this psychiatrist will not listen, find one who can. Talking about huring himself is definately a red flag. Sending positive thoughts.....

Sharon

 

[klmno]

I agree with Sharon- I think a second opinion might be in order. I'm glad you're keeping a close eye on him. Thoughts of hurting himself may come and go and never hurts to be too cautious about that.

 

[Mandy]

I don't have a teen but have taken anti-depressents before and agree their is a HUGE warning pamphlet in most of them abt. teenagers and suicide. Please stress to the dr. how worried you are abt. this!! Good Luck!!

 

[BusynMember]

I have bipolar II. If he has it, and it's all opinion with doctors plus seeing their reaction to medication, stimulants and Zoloft would probably make him worse, even suicidal. I recommend a fresh, second opinion and I'd never never ever count on school to diagnose. they just don't hire the best and brightest. I'd go to a neuropsychologist. If there is bipolar in the family it is very hereditary and not everyone with bipolar has obvious highs and lows. A mood stabilizer would then be the medication that would work the best. I was on Zoloft once (50 mgs.) and ended up in the hospital within two weeks. Please...get another opinion and don't rely on school or a therapist. He's getting older--go to the big gun--I like NeuroPsychs best. Some go to Psychiatrists (with the MD). Good luck.

 

[maril]

difficult child is okay today and presently is at school. Whew!!!

Omigosh -- when I logged on this morning and read all of your posts, I was so grateful. You are all so, so helpful and supportive.

I did not call his psychiatrist yet this morning. I want to collect my thoughts and be sure to clearly list my concerns and difficult children behavior.

Stimulants and antidepressants can BOTH cause someone with bipolar to cycle. Until the cycling is stabilized the person really cannot function at their best. And sometimes not at all.

Stimulants can also cause aggression.

Zoloft can cause depression and aggression. My son was fine for about 2 months on zoloft. By month 4 he was dangerous, MOSTLY because this medicine. It seems to do that more in boys, based on anecdotal evidence from other parents.

With both stimulants and aoloft in his system, your sons moods CAN'T stabilize. He needs a medication wash and THEN a trial of mood stabilizers and other medications to treat the bipolar.

Thank you, susiestar! The information you gave addresses my concern that if there is possibly a missed diagnosis of bipolar, medications taken might be exacerbating that condition. I am also glad you made mention of mood stabilizers.

Your son is lucky to have you as a mom.

Just a note that difficult child started stimulants in middle school but has had only a total of 6 months' time collectively on all four that have been tried. Out of the four stimulants that were tried, two were methylphenidates, in which he developed reactions of hallucinations with one and then rage with the other; each was quickly stopped by the doctor (maybe this is one of those red flags?) As far as his fourth and present stimulant Vyvanse goes, he is on a low dose and claims it helps him focus in school; however, he says it sometimes makes him feel hyped up and irritable.

The generic Zoloft was just started about mid October (after being 302'd for trying to hurt himself/short stay at psychiatric hospital/discharged with diagnoses of ADHD, ODD, substance abuse; aftercare in place). I am not clear on this but think the generic Zoloft was started because of anxiety. Also, after his psychiatrist's instructions on recent visit to increase it to 100 mg, he continues to take it at 50 mg in the morning (except for one day out of the last nine since the visit). I will let the doctor know that.

You are all great. Have a wonderful Friday, and here's to a peaceful and restful weekend.

 

[pepperidge]

Marilynne,

What you describe is huge, huge red flags. I have had two children flip out on anti-depressants and one who can't tolerate stimulants (though needs them!). We have had great luck with Lamictal (a mood stabilizer) and Adderall for one of my kids. With his hospital history etc. I would find as quickly as I could--real quick--a psychiatrist who believes that bipolar exists in children. Especially since you say you have a history. One of the first medications that my very depressed oldest was put in 3rd grade was Lexapro (an anti-depressant), at a full dose. Two days he was knocking over desks in his classroom. We got him off of that real quick and got a different psychiatrist. I am not anti anti-depressant, and my kids have tried plenty of medications that haven't worked from psychiatrists trusted. There is a great deal of trial and error unfortunately. But I would be asking the kinds of questions you're asking and I would be lobbying for major medication changes.

Have you read the book the Bipolar child? It has a very good chapter about medications. I don't even know whether my children strictly speaking have a diagnosis of bipolar. Many of us here worry far less about the actual diagnosis, which is hard to make in many cases, and worry far more about finding a competent psychiatrist who takes a very careful approach to medications but is willing to believe that kids have something other than ADHD.

Good luck. It is a very hard road to find medications that help. But when they do, many of us have been amazed at what a difference it makes.

Pepperidge

 

[maril]

Hi, MidwestMom. I just saw your post. Thanks.

I guess I was typing my previous post while you were posting yours. Sometimes it takes me a l-o-n-g time to finally submit a post because I have to edit more than once, as I tend to go on and on, especially when I am upset!

Actually, we have been pursuing a definitive diagnosis after the results from the school evaluations (ADHD, likely inattentive) but have not been successful, i.e., pediatrician, then psychiatrist along with-therapist, then most recent psychiatrist along with-therapist (quit going to the therapist a while back but difficult child still goes to the psychiatrist). It is very trying! This most recent therapist difficult child had seen was really resistant to any input from me. in my opinion, it was a dead end but I kept my emotions in check around difficult child; however, difficult child said he didn't feel comfortable with him, anyway. Oh well, water under the bridge and we need to move on.

I have heard from others who also recommend seeing a neuropsychologist; I assume a psychiatrist would be necessary as well for dispensing medications?

I am sorry you had to go through the difficult time as a result of the Zoloft. That really stinks.

I am seriously considering the idea of a second opinion. My husband just got home from work today and I am running all this by him. He agrees with me that there may be something more going on when we reflect on difficult children behavior, etc., especially in recent years.

Have a great day and thanks, again.

 

[maril]

Marilynne,

Have you read the book the Bipolar child? It has a very good chapter about medications. I don't even know whether my children strictly speaking have a diagnosis of bipolar. Many of us here worry far less about the actual diagnosis, which is hard to make in many cases, and worry far more about finding a competent psychiatrist who takes a very careful approach to medications but is willing to believe that kids have something other than ADHD.

Good luck. It is a very hard road to find medications that help. But when they do, many of us have been amazed at what a difference it makes.

Pepperidge

Pepperidge: I found your post very helpful and thank you for sharing. What an eye-opener for me.

Re the above quote: I have not read the book but did bookmark a website that gives information about it and will check into it. Also - Yes, it would be great to find a medication that would work and to have that peace of mind of having an effective medication and the right diagnosis.

Best wishes to you and your kids.

 

[TerryJ2]

Hi, Just wanted to lend support, and send strength and clarity for dealing with-your psychiatric. You will have to be firm in addressing the issue, not questioning. {{hugs}}

 

[Mandy]

I am about halfway through The Bi-polar Child and it is EXCELLENT in describing medications, all their side effects, and what medication is good for which diagnosis!!!

 

[klmno]

I, also, found a book called something like "New Hope for Teen & Adolescent Bipolar" very helpful.

 

[Star*]

Marilynne,

I don't want to alarm you but.....I wanted to share my experience with you. I took Zoloft for a while and had "idealizations" of suicide. I mean I wasn't going to go through with it - because I was after all ON the medicine, but I would sit and think at benign moments how to plan hanging myself. When I told this to my therapist - we stopped Zoloft cold.

My son at age 10 was put on it - and he attempted to hang himself in a makeshift closet with his shoe strings. Later at age 16 he was put into Department of Juvenile Justice and tried to hang himself with a sheet. I found out that morning when he called crying telling me they had forced him to take Zoloft, didnt' tell him what it was and that if he didn't take it he would get in big trouble.

My son is a possible BiPolar (BP) too - he feels he is. Too many things he can't explain mood wise. But never a firm YES.

Just wanted to let you know and maybe if you're close to your son ask him if he's ever thought about how he would kill himself - If he has a plan? I'd seek to get him off the Z - and find alternative medications.

Hugs
Star

 

[butterflydreams]

Marilynne,

I wanted to offer you support as well. Both my children have been diagnosed as rapid-cycle bipolar. My daughter (16 just recently). Up until a few months ago, we just thought her depressed, until she started rapid cycling, then her psychiatrist knew for sure. We are still trying to get her medications doses right. We seem to be on the right track, she is still cycling, just not as rapidly. As she was growing up, there were never really any warning signs.

However, with my son, there was always some indication something was kind of off. He has been (as you can see from my signature) in and out of the hospital for the last year as we have been getting him stabilized. He is starting back to regular school Monday and is like a totally different kid now. he does have some cycling going on, but he is definitely better than he was.

Good luck to you and I would definitely look for some different help.

Hugs,

Christy

 

[maril]

Wow. I must admit, dealing with difficult child's crisis has left me a bit out of it today; still, I kept busy, including getting hold of psychiatrist, then sorting through with husband what steps to take next, as well as trying to get some other necessary tasks done.

TerryJ2: You hit the nail on the head - I do approach things in a questioning way sometimes when I must instead be firm. An Achilles heel I am trying to remedy. Thank you for your help.

FightingforCole and klmno: Thanks for the suggestions on books! I will explore.

Star*: Thanks for sharing your experiences. It must have been very painful for your son and you. I am glad you are past that.

As far as my difficult child talking about how he would kill himself - he has told me on two separate occasions recently how he would do it. Back in October, even before he was prescribed the generic Zoloft, I caught him trying to hurt himself. He was then hospitalized, which I described in previous posts.

butterflydreams: I am happy for you and your children that things are looking up. I hope all continues to improve. Thanks for your kindness, also.

I am a bit lost on the term rapid cycling; I have read about it and gather that is the way bipolar manifests in teens (?) Is it alternating rapidly between depression and mania?

 

[susiestar]

If he was prescribed the Zoloft in October, he is right about at the time the suicidal thoughts would be VERY active. If your psychiatrist won't listen you may need to take him to the ER or to a psychiatric hospital for an evaluation. They can help you with services and a psychiatrist who WILL pay attention to you.

Many more hugs on their way to you (I am a hugger!). Remember when you are talking to the "experts" that they are "expert" on whatever field, but YOU are the EXPERT on your child. YOU live with him, carried him inside your body (or welcomed him into your heart just as if you did carry him inside you if you adopted him - it is a mom thing), and KNOW him. And know we are ALL with you in the doctor's office. We are there to support you and give you the strength you need to advocate for your son.

I read about the docs you have been to. I want to suggest you see a neurologist and get a sleep deprived EEG. There is a chance that your son has seizures. They can cause difficult child behaviors and NOT look like the stereotyped seizures. Esp if they thought he had inattentive ADHD - my daughter was diagnosis'd with this by a psychiatrist. I took her to a neuro and had an EEG run, on the advice of another mom here.

My daughter has Absence Epilepsy - NOT ADHD. We DID trial strattera before we got the EEG done. It did not help her. But the epilepsy medications DO help.

I just wanted to suggest that.

HUGS!

 

[klmno]

I'm still having my coffee this morning so I'm not fully awake or alert yet- please forgive me if I'm covering something that's already been discussed. I'm thinking if your son is diagnosis'd as having depression and you think it really is more like bipolar (which I tend to think is a spectrum in itself), you could log down any change in mood, temperment, sleep patterns, behavior, abilities- (such as can he fly through homework some days but struggle and become anxious or frustrated other days), characteristics, such as some days withdrawn but some days excessively talking, etc., and take these to the psychiatrist.

 

[maril]

klmno: Thank you. Very, very good suggestion to start a log! Much better than me sitting here running through a mental checklist of everything that has occurred with difficult child.

In the mean time, I am on pins and needles about continuing his medications but the psychiatrist did not say to stop anything or decrease anything when I spoke with her yesterday; husband wants me to listen to her about the medications and continue to explore our options. difficult child's psychiatrist also recommended that he go to a partial program (difficult child has to be in agreement), which would be all day, including schooling and counseling, as opposed to an inpatient psychiatric hospitalization (this was suggested to me upon my describing how difficult child is behaving in conversation with psychiatrist yesterday). To complicate matters, difficult child is already currently in a partial program for D&A, only halfway through; not realistic to do both programs at the same time. Obviously, we have to choose which program would serve him better at this time and, of course, he has to be willing to go, if we choose the behavioral partial program.

Also, with the wise suggestions given here to seek a second opinion, I will be researching finding a psychiatrist for that purpose; pretty crucial.

 

[BusynMember]

If he starts getting more intense and suicidal, in my opinion get another doctor's advice soon, even a family practitioner. Any doctor can help you wean off medications (and it is NO picnic to wean off SSRIs--that can cause a person to actually feel MUCH worse for a while. The doctors never tell you about SSRI withdrawal syndrome.)
Zoloft can cause a lot of different bad things, including mania or even psychosis. It takes a while to hit it's peak because SSRIs build up in your system. My daughter took Prozac, which is also an SSRI, and pulled a knife on herself. We called the police and they took her to a hospital. We checked her room when she was gone and found knives under her mattress and suicidal poems and letters. Antidepressants can be dangerous. I could never have taken 100 mgs. of Zoloft. I couldn't handle 50 mgs.
If the medication doesn't seem like it's doing any good, maybe it's doing harm. These drugs are hit or miss--this from somebody who is 55 and has needed to take medications since age 23. Doctors are often wrong about medications. You need to keep an eye on the behavior of your child and trust your Mom Gut.