difficult child diagnosis'd with BiPolar (BP) II, question about some medication suggestions...

Discussion in 'General Parenting' started by hearts and roses, Jan 30, 2013.

  1. hearts and roses

    hearts and roses Mind Reader

    Back about six years ago, difficult child was diagnosed with a 'mood disorder', but we were never given a very good description of what that meant to her specifically. At the time, her psychiatrist had switched her from celexa to lexapro, which subsequently sent difficult child into a hypo manic state, which eventually led to her getting into a very dangerous situation and she was thus kidnapped and sexually assaulted. At that point, the psychiatrist said, "Oh, your difficult child has a mood disorder so we need to take her off the antidepressant and put her on a mood stabilizer". psychiatrist switched difficult child to lamictal, which after only four days ended difficult child in the hospital with shakes, racing heart and loss of natural gait. She couldn't walk or stop shaking. After that, difficult child became very non compliant in terms of taking any medications but she did continue the risperdal to help with her tics at the time. Eventually, she stopped all medications and self medicated with pot and a little drinking. She was constantly disagreeable, angry, verbally abusive and mean, crying and in a state of hypomania. Her gyno started her on the depo provera shot to help with severe pmdd...mood swings. It helped tremendously between the ages of 18-21, giving difficult child plenty of time to mature a bit.

    This past November, I saw difficult child at a very scary place that I haven't seen since she was 15...crying constantly, lashing out, mean, and worst of all, suicidal. Her depression had reached an all time low. We were unable to find a psychiatrist at the time, especially so close to thanksgiving and Christmas, so we desperately reached out to our reg doctor, who upped difficult children dose of Prozac (she started it last year for her pmdd) from 20 to 40 mg. it has helped a lot. In the meantime, we found a psychiatrist...we saw him today.

    After about an hour of interviewing and some background and medication analysis, Q&A, he stated that he felt difficult child has Bi-Polar II. He suggested either lithium or depakote, leaning more towards depakote.

    Honestly folks, it's been a long time and a lot of detaching since I've had to think about this. I'm doing some research. I do not remember if difficult child ever tried depakote, I'm thinking maybe she did, but I honestly can't remember. So, finally, what I'm looking for is some input on lithium or depakote. I know many of your have either used it yourselves or had kids who have. Please keep in mind that difficult child is 23 years old, smokes cigarettes and pot, but doesn't drink. Please, no lectures about her pot smoking...I gave that fight up already. It is what it is and quite honestly, in the broad spectrum, it's a small issue to me. I'd like to see her stabilized, shower regularly and maintain a healthy diet long term. So, thanks in advance! I value your input more than you know and trust you all implicitly.
     
  2. HaoZi

    HaoZi CD Hall of Fame

    Those are both heavy-duty medications with heavy side effects on health. Have you considered something like what Storm uses? The tegretol? Not sure if I spelled that right, but it has a much lesser side effect profile. Maybe with an AAP added in like Saphris? Storm needs both a stablizer and an AAP (she takes Abilify but that can add weight, and since pot can also add weight and Saphris seems weight-neutral...)
     
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Depakote struck out in our house. First, teen daughter took it. When she was abusing drugs, she got diagnosed with bipolar. She doesn't actually HAVE it, but the drugs made it seem as if she did and she did take Depakote for a few months. She called it her "stupid" pill because she couldn't think on it and said she felt like sleeping all the time. It's a huge weight gainer too so she finally tossed it in the trash. My young son also was misdiagnosed with bipolar and was put on Depakote. My biggest memory of that was his non-stop hunger and screaming when we wouldn't let him eat, especially sugary sweets and starches. He gained a lot of weight on it and, like with my daughter, it seemed to make him dopey and out of it. Again, though, neither really had bipolar.

    I took Lithium and it made me very dopey and I felt suicidal. I am not a fan of how mood stabilizers make you feel. I have a mood disorder too, but it is well regulated on an antidepressant and one tranquilizer. I just don't like how mood stabilizers make you feel...worse than the disorder to me. Lithium is another weight gainer. My son was on that too and had the same type of hunger, perhaps not quite as bad as with the Depakote.

    Remember, though, everyone's body chemistry is different. And I am really lucky that I don't get manic on my antidepressant. medications are a game of hit/miss.

    Although I'm not going to lecture you about pot, it can interact with the other medications and make them not as effective. If she is doing stronger drugs, even moreso. In order for prescription medications to really help, she needs to be clean.

    I'm sorry you are going through this. I had so many mood disorder type diagnoses, I don't care what it's called this year...lol. I've been diagnosed with manic/depression, bipolar II, bipolar, depression, unipolar depression, and mood dysregulation disorder. Don't worry about the diagnosis. Just see what works and helps. Gentle hugs :)
     
  4. hearts and roses

    hearts and roses Mind Reader

    Thank you for your detailed message, MWM. I have to agree, I am not thrilled with treating the disorder rather than the symptoms and I know it's been discussed a lot on the board.

    She doesn't do any other drugs and doesn't drink alcohol. She smokes a couple of puffs from her tiny bowl in the morning and then again in the evening. She uses it to treat her severe anxiety. She was using more before the doctor put her on Prozac. Now she is using less. If she were taking other drugs and drinking, I would be more up in arms over it...when she was a teen, I was glad she stopped taking her medications because I knew she had begun drinking a lot and smoking pot and god knows what else (actually I do know now and it would have been very scary).

    My feeling is that with just the right amount of Prozac and the addition of Xanax for anxiety attacks, she's mostly stable. She does have impulsivity, such as shopping and overspending and then forgetting she did that. She can sometimes be excitable, but her mania is still fairly low level. Risking her hupomania by remaining on the Prozac is more desirable to me than deadening all her emotions by taking a mood stabilizer. I guess I have to do more research. Ultimately, it's up to difficult child. She said she would like to stop the Prozac because she has zero sexual desire and her fiancé is not happy about that and neither is she!

    Thanks again!
     
  5. hearts and roses

    hearts and roses Mind Reader

    Haozi, I will look into the tegretol as an alternative...gosh I feel so out of the loop! Thank you!
     
  6. TerryJ2

    TerryJ2 Well-Known Member

    Jo, I'm so sorry that your difficult child is having serious issues again, but you gave a great encapsulation and history.

    My son is on lithium and is doing very well. I am hoping to up it again in Feb, another 150 mg. He's on 600 right now. Most people with-bipolar are on 1200, if I remember correctly.
    It does take a while to titrate up to the right level but it really works.
    We've never tried Depakote so I have no info for you there.
    Also, I'm sure you're aware that some pot smokers experience paranoia, and I'm wondering if your difficult child's anxiety symptoms fall into that definition.

    Many, many hugs and best of luck.
     
  7. SearchingForRainbows

    SearchingForRainbows Active Member

    Jo,

    Haven't "seen" you in awhile and have been wondering how things are going. So sorry to hear that your difficult child is struggling again! difficult child 1 is bipolar and as a teen he was on a combination of Trileptal (mood stabilizer) and Abilify (anti-psychiatric). We were very fortunate because once he was taking the correct dosages, this combination worked well. difficult child 1 is naturally very thin and didn't gain weight although he was always "pigging out." difficult child 2, while he isn't bipolar, had seizures that began when he was a toddler and ended by the time he was out of elementary school. He was put on Depakote and it helped. Like difficult child 1, difficult child 2 is also very thin and while he gained a bit of weight, it wasn't much.

    Unfortunately, when difficult child 1 left the "nest," he stopped taking his medications. He told us that they made him feel spacey. Now I think he self medicates by drinking excessively. While he seems to be doing well, I know things can change at any moment... It scares the "garbage" out of me!! difficult child 2, on the other hand, doesn't take any medications although his therapist has been trying to get him to take an anti anxiety medication but without any luck. Unfortunately, in difficult child 2's case, he really needs one as his anxiety is always through the roof. He said he'll never drink because it isn't good for him. (He does lots of other things that aren't good for him but I won't hog your thread.) Of course, difficult child 2 is socially very immature and although what I'm about to say can be taken the wrong way, I wish he had some friends, went out for a drink every now and then.

    Sorry, I guess I really have been hogging your thread!! I really wish I had some helpful information for you. Like you said, it really boils down to how the medications make her feel. If they squash her sexual desire, and could deaden her emotions, make her gain weight, then I can understand why she refuses to take them. Mental illness is the absolute pitts... What an understatement!!

    Your difficult child is very fortunate to have you by her side as she struggles with these issues. Once again, I'm very sorry things are so tough for her right now. Thinking of you, praying that your difficult child finds the answers she needs to remain stable, be happy... Many hugs... SFR
     
  8. hearts and roses

    hearts and roses Mind Reader

    SFR - you didn't hog my thread, you shared your experiences, which is what I was looking for, so thank you!

    I do not think that difficult child should change what she is doing and I'm not sure exactly how she feels about switching her medications and adding a mood stabilizer...but I do know she is concerned about the times when she acts out and forgets it happened. She really does this a lot - always has...I don't know the right answer, but I think I may have a little ptsd from when she was younger and we had to try different medications and all the tweaking seemed to hurt her rather than help her. The only medications I can say were a godsend was the risperdal and celexa or zoloft...everything else? Absolute garbage!!!

    difficult child is at the dentist this morning and I'm hoping she stops by my office on the way home so I can check in with her and see if she's given this any thought or talked it over with her fiance.
     
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    That's the problem with mood stabilizers. They may calm you to the point of making you feel like a zombie, but a lot of people can't stand the foggy headed, dead feeling they often give you so they quit taking them. Since I did take them, I get it. I tried Tegretal too and it made me just as zombied out as t he others, although not as hungry. Maybe psychiatrists prescribe too high a dose?
    No matter how sick you are without medications, nobody likes the feeling of being dead inside. Also, in my case, they made me even more depressed and immobilized. Mood stabilizers are also famous for cognitive dulling, in which you are just not as able or as sharp as you were without them. That's what my daughter meant when she called Depakote her "stupid" pill. It made it very hard for her to think and she was in Cosmetology school at the time. And she had always been very bright...this cognitive dulling scared her.
    On another note, I'm a little unsure why your child would forget her fits. Have you ever looked into epilepsy? She ever see a neurologist?
     
  10. hearts and roses

    hearts and roses Mind Reader

    MWM, she hasn't seen a nuerologist since she was around ten years old, when she was first diagnosis'd with Tourette's Syndrome. The more I learn, the more I am leary about her taking a MS. Ugh.
     
  11. Bunny

    Bunny Active Member

    difficult child has never been on lithium, but I have a friend whose son was on it with fantastic results, at least while he chose to take it.
     
  12. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I'd encourage her to see a neurologist again.

    As for mood stabilizers, I think if you have real bipolar, as in manic psychosis, you have no choice but to take them, but I know people with bipolar I who quit because of that foggy, unreal feeling too. I just know that parents who have never taken these medications often do not understand why their difficult child's stop taking them. I'm betting that most of the time the side effects are just intolerable, worse than the psychiatric illness. I do think some of that is from psychiatrists who insist on raising doses until they are so high that the person can no longer think straight. I've been there. I've gone off medications because it's scary to feel so out of it. In the lithium saga, I kept telling the doctor I felt like I wasn't even real, like I was walking in a dream. He said it was "anxiety" and kept upping the dose, which made it worse. I was so drugged, I could barely remember my name. When I finally quit cold turkey, which I now know you aren't supposed to do but am not sure I would have done differently anyway, I waited three days, Lithium free, and suddenly was clearheaded as ever and not even depressed anymore. I took my butt to a new psychiatrist who did a lithium level on me. It was 1.6, which was extremely high...toxic for somebody who, at the time, was only 96 pounds and sensitive to medication. This was the level after three days of not even taking Lithium. I never took it again. I tried tegretal once, noticed the same dreamlike sensation, and threw it out.

    Part of the medications problem is how psychiatrists prescribe them. They tend to overmedicate. It never occurs to them that maybe the drug is causing the problem. Instead of ever trying to lower a dose, thinking perhaps a person is drugged up, they tend to up the doses or flip medications so that the person remains overmedicated. I had to monitor medications on my own once I learned this. I refuse to take anything if it drugs me up. Period. I decide what I take and what I don't take, not based on stubbornness, but based on how a medication makes me feel. I am only too aware of how psychiatrists tend to prescribe too many drugs to one person. Overmedication feels horrible and is no better than no medications at all.

    I am not your daughter, b ut it sounds like this weird dreamy "I-am-not-really-alive" feeling is why she quit her medication. I've been in the phospital three times and we patients used to talk about the medications and this spacey feeling. It is a huge reason why many psychiatric patients become non-compliant. Family members who have never been on them, just don't understand how awful they can feel. Many times they think we are just being difficult children, refusing to help ourselves. That is sometimes the case, I'm sure, but it is also often how bad the medications make us feel. Self-medication often feels better because WE are in control of how drugged we are! I never did self-medicate, but I do understand why some people would rather control their own alcohol or pot doses than take heavy duty psychiatric medications that sometimes don't help and that also have major side effects. I do get it.

    It's a very delicate art to finding the right medications and the right doses. It took me almost fifteen years to find medications that actually worked. It doesn't happen overnight.

    I feel for you; I feel for your daughter. Take care.
     
  13. TerryJ2

    TerryJ2 Well-Known Member

    I agree, MWM, that the dreamy, foggy state may be why difficult child quit taking the medications.

    As for doctors who prescribe too many medications or too high a dosage, when it's the medication itself that is causing the issue, read "The Boy Who Loved Tornados." You will tear out your hair in frustration and sympathy.

    know she is concerned about the times when she acts out and forgets it happened.


    This is a good thing, that she believes you and is concerned about it. Reminding her of this will help her get back on and stay on medications. If not now, then at some point.

    In my NAMI parent-to-parent class, there were several parents whose kids went through that. It seemed to be classic for bipolar psychosis and other things. My heart aches for you all.
     
  14. HaoZi

    HaoZi CD Hall of Fame

    Trileptal and tegretol, while used as stabilizers, are technically antiepileptics.​
     
  15. JKF

    JKF Well-Known Member

    easy child/difficult child has been having some more issues than usual lately. The regular forgetting everything and in his own world with some anger and sadness issues mixed in. He's been lying a LOT lately and had a fairly alarming issue at school yesterday. I took him to the psychiatrist today and she immediately took him off of the Intuniv bc it can cause aggressive behavior in some kids. easy child/difficult child is usually a very pliable laid back kid but definitely much more argumentative and aggressive since the Intuniv was added in Dec. So bye bye Intuniv. After a he had a long session with the psychiatrist she called me in. She feels he has a mood disorder in addition to the ADHD and she feels its very likely he may be bipolar since both his biodad and brother are bipolar.

    She prescribed Trileptal in addition to the Vyvanse. He's starting at 1/2 of a 150 mg tab each night at bedtime and then in two weeks he'll double that dose and take it twice a day. Does anyone have any experience with this medication??
     
  16. JKF

    JKF Well-Known Member

    Ok this whole "reply" was supposed to be a new thread but somehow I posted it here. I thought it got eaten by cyberspace. I started a new thread so if any of you have advice or experience wit this medication please let me know. Thanks!!!
     
  17. HaoZi

    HaoZi CD Hall of Fame

    Storm did well on Trileptal until she outgrew it and had to go to tegretol instead. Was a good stabilizer with few side effects for her.
     
  18. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I am on two mood stabilizers and I am anything from foggy or spacey. Even on all my medications I am not drooling in the corner. I wont take anything that would make me feel like that.

    Its a shame that lamictal had that effect on her. I understand her complaints in the libido dept. That is something I have always made my doctors aware of. I am not dead yet! I may be middle aged and fat but Im not dead yet. There has to be something to look forward to in my life...lol. Has she ever tried wellbutrin? That doesnt kill the libido. She might be interested in that along with the Saphris to help hold everything all together. Just my slightly informed opinion.
     
  19. hearts and roses

    hearts and roses Mind Reader

    difficult child is VERY sensitive to medications, all medications, as am I. The lowest dose and we feel it right away. I explained this to the psychiatrist and he said it was impossible to notice any change after only two days of missing Prozac. difficult child told him that if she misses two days of her Prozac, she notices it, as do I. He said that was impossible. I then piped up and said I have the same reaction to medications, very very sensitive and the lowest dose usually is adequate or near adequate...which explains why I am still only taking 20mg of Prozac and difficult child is only on 40mg. I just get the feeling that this psychiatrist would be hung ho about changing her medications and putting her on a so called therapeutic dose, which may end up being too much for her.

    Since difficult child is finally at a point where she is willing, truly wanting, to address these issues, I would hate to sabotage her efforts by over medicating her, Know what I mean?? For example, when she was on celexa, she only took 10 mg; risperdal? It was half of a .25mg tablet. Xanax? It's .50mg at night. difficult child is very sensitive to medications, all medications. We are proceeding with caution.

    Thank you all for your replies!
     
  20. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Oh...if xanax helps her at all...ask about the extended release xanax to take at bedtime because it works for 24 hours. That might make all the difference in the world for her. the lowest dose for that is 1mg but over 24 hours that would be a low dose. Probably equal to what she is getting now. It releases so slowly in her blood stream and the largest amount would hit her during the night while she is sleeping.

    As far as the pot, I get you and I wouldnt get into that fight either. When she is ready she will stop on her own if she so wishes.
     
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