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Depression or bipolar?
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<blockquote data-quote="smallworld" data-source="post: 14207" data-attributes="member: 2423"><p>Hi Chris, I bet you knew I'd be popping in to weigh in. </p><p></p><p>As you know from our many email discussions, my kids don't entirely fit the BiPolar (BP) diagnosis (on the hypomania/mania side -- they're definitely depressed), but they flip out when they take SSRIs. We know this, of course, because the first medications they ever took (save stims for my son, which he tolerated well) were SSRIs. You probably already know this, but 30 to 50 percent of kids first diagnosed with depression actually have BiPolar (BP). It is very challenging to tease out what is unipolor vs. bipolar depression. So . . . what we have done is lay down mood stabilizers first and then add in small doses of ADs (difficult child 2 has been on Lexapro since early December, and difficult child 1 is starting Lexapro this weekend). We start really low (2.5 mg Lexapro) and then raise the dose every 2 weeks. That way we can sense problems early before flipping over into full-blown mania (which happened in 5 days when difficult child 1 trialed Effexor). </p><p></p><p>In easy child's case, because of family history, her psychiatrist prescribed Zyprexa first because it has both anti-anxiety and mood-stabilizing properties and then added in Prozac (for her choking phobia). The beauty of Prozac is that it comes in a liquid that can be given in tiny doses. We started at 2 mg and cautiously went up every 3 weeks. She's now at 12 mg, and honestly, we're having some issues with meltdowns. I don't know if we're seeing some activation, but husband and I are a tad concerned. I have a call into easy child's psychiatrist this morning. </p><p></p><p>Unfortunately, medications are a crapshoot. You gotta try or you'll never know. Your difficult child is only on 5 mg Abilify, and clearly, it's not doing enough or targeting existing symptoms. I think you have a few choices -- try an AD with the current AP, try a different AP and then add in an AD, try a different mood stabilizer and then an AD if necessary. You're right that Prozac is the only AD approved to treat depression in children, but psychiatrists frequently prescribe others off-label.</p><p></p><p>Hope you can figure something out.</p></blockquote><p></p>
[QUOTE="smallworld, post: 14207, member: 2423"] Hi Chris, I bet you knew I'd be popping in to weigh in. As you know from our many email discussions, my kids don't entirely fit the BiPolar (BP) diagnosis (on the hypomania/mania side -- they're definitely depressed), but they flip out when they take SSRIs. We know this, of course, because the first medications they ever took (save stims for my son, which he tolerated well) were SSRIs. You probably already know this, but 30 to 50 percent of kids first diagnosed with depression actually have BiPolar (BP). It is very challenging to tease out what is unipolor vs. bipolar depression. So . . . what we have done is lay down mood stabilizers first and then add in small doses of ADs (difficult child 2 has been on Lexapro since early December, and difficult child 1 is starting Lexapro this weekend). We start really low (2.5 mg Lexapro) and then raise the dose every 2 weeks. That way we can sense problems early before flipping over into full-blown mania (which happened in 5 days when difficult child 1 trialed Effexor). In easy child's case, because of family history, her psychiatrist prescribed Zyprexa first because it has both anti-anxiety and mood-stabilizing properties and then added in Prozac (for her choking phobia). The beauty of Prozac is that it comes in a liquid that can be given in tiny doses. We started at 2 mg and cautiously went up every 3 weeks. She's now at 12 mg, and honestly, we're having some issues with meltdowns. I don't know if we're seeing some activation, but husband and I are a tad concerned. I have a call into easy child's psychiatrist this morning. Unfortunately, medications are a crapshoot. You gotta try or you'll never know. Your difficult child is only on 5 mg Abilify, and clearly, it's not doing enough or targeting existing symptoms. I think you have a few choices -- try an AD with the current AP, try a different AP and then add in an AD, try a different mood stabilizer and then an AD if necessary. You're right that Prozac is the only AD approved to treat depression in children, but psychiatrists frequently prescribe others off-label. Hope you can figure something out. [/QUOTE]
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