Input on Mood Stabilizers

Discussion in 'General Parenting' started by Alisonlg, Apr 30, 2007.

  1. Alisonlg

    Alisonlg New Member, I'm working on getting an appointment very soon with the psychiatrist to review difficult child and his medications. I really want him OFF the Adderall and I want to discuss alternatives to adding an SSRI (like Zoloft) to his medication plan, which is what they wanted to add early this week.

    It's pretty obvious that the Seroquel (or the dose he's on, which I don't know what dose he's on) is not enough and that the Adderall has been of no help because A) he's back in the psychiatric hospital and B) he's off and on hyperactive, he's punched a window for no good reason, he's just still totally unstable.

    My gut says this kid has a Mood Disorder...possibly Early Onset Bi-Polar (EOBP), but I'm no DR. From what the SW says (and again, I want to get some info straight from the psychiatrist), they think he has anxiety issues. They want to add the SSRI with the Seroquel to help with the anxiety. I'm afraid it's going to make him manic. I want to walk in there armed with knowledge and get their opinion on maybe adding a mood stabilizer INSTEAD. What are your thoughts?

    I did some quick browsing on and saw that an off-label use of Trileptal is anxeity and it had a low side effect profile, as compared to it's counterparts (i.e. Topamax, which I take for migraines), so maybe they'd consider THAT? Of course, would that be FAR more serious a risk to try than Zoloft? Would they laugh in my face? Is there another class of Mood Stabalizers that should be considered first? I know things like lithium and such are pretty heavy duty.

    Just looking for your input on the mood stabilizers, as my gut tells me MY KID may function much better with a mood stabilizer with the seroquel than any stimulant or SSRI, but maybe I'm jumping the gun way to early in the game??? Maybe they'll laugh in my face? Maybe they'll think I spend too much time on Google? LOL
  2. smallworld

    smallworld Moderator

    Hi Alison, me again. You're going to get sick of hearing from me.

    Anxiety can lie at the heart of bipolar disorder. But it can also go hand-in-hand with unipolar depression, be a part of Autism Spectrum Disorders and even be a diagnosis unto itslf. My easy child's only diagnosis is anxiety, and it has manifested itself over the years as selective mutism, a choking phobia and Obsessive Compulsive Disorder (OCD) tendencies. Figuring out where your difficult child's anxiety emanates from will determine in part how you decide to treat him. With anxiety on its own or even part of certain other disorders, SSRIs like Zoloft are appropriate choices. But if anxiety is part of bipolar diosrder, Zoloft could send a child into mania. And even if the child does not have bipolar disorder, there is still a risk of antidepressant-induced mania. Unless you have more concrete diagnostic information, there is absolutely no way of predicting how your son will respond to Zoloft.

    In my many years of dealing with medications and my own kids, I have found that psychiatrists seem to readily prescribe stimulants and antidepressants, but tend to go to mood stabilizers as a last resort. That is what happened with my two older kids. Their psychiatrists prescribed mood stabilizers only after they had bad reactions to SSRIs, which were originally prescribed for anxiety and depression. And I don't fault the psychiatrists in any way. We don't have a family history of bipolar disorder (do you?), and their symptoms seemed to merit treatment with SSRIs. I'm not saying that this should happen in your case, but I think you have to get a firmer grip on diagnosis before the psychiatrist determines course of treatment. Can you have your difficult child evaluated elsewhere before you decide to go ahead with any more medications?

    The first-line mood stabilizers are Lithium and the anticonvulsants Lamictal, Depakote, Trileptal and Tegretol. Just like any psychotropic medications, they are not without risks. In my experience, their best use is not for alleviating anxiety, but rather for smoothing out the ups and downs in mood. Depakote was very good at containing my son's agression and agitation. Lamictal has been very good at lifting my son and daughter's moods and generally making them more stable. We have never used Trileptal because our psychiatrists have been underwhelmed at its efficacy for adolescents. And even when we contemplated a mood stabilizer for easy child earlier this year, her psychiatrist said she wouldn't choose Trileptal because it had mixed clinical reviews. But this is just the opinion of three psychiatrists. What matters is the opinion of the psychiatrist treating your son. And if you don't think she's doing a good job, you need to find someone better.
  3. smallworld

    smallworld Moderator

    Just wanted to add: Seroquel can help with anxiety, and it is used to augment bipolar treatment so it shouldn't send your son into mania. Maybe he's not at a therapeutic dose . . .
  4. Nancy

    Nancy Well-Known Member Staff Member

    Lamictal has worked very well for us. There are very few side effects and difficult child tolerates it very well. Her mood is much better on this medication.

  5. Alisonlg

    Alisonlg New Member

    Smallworld- NEVER sick of hearing from you! If anything- you'll all be sick of hearing from ME! :wink:
  6. oceans

    oceans New Member

    This is what happened with my son.

    His first diagnoses was ADD and Depression. psychiatrist started with stimulants. When that did not work, he added antidepressants. That did not work either, and he had bad reactions on many of the antidepressants. One psychiatrist thought his mood disorder needed to be watched closely over the years for bipolar, but he would only add risperdal. That had a small good response and then stopped working. On a high dose together with an antidepressant it caused his moods to swing up and down like crazy. We went a very long time with the psychiatrist refusing to try a mood stabilizer because he only saw depression. We tried many,many antidepressants with no luck and with him getting worse.

    He agreed to add Lithium to the antidepressant and his TSH skyrocketed so we had to take him off before he reached therapeutic dose. After all of that....I finally talked him into adding Lamictal. Before we had a chance to add it, he ended up in the first psychiatric hospital and they added a second antidepressant to his first. He did not get better. I finally talked them into adding the Lamictal on the bases that it was the outpatient psychiatrists next plan anyway. They FINALLY added it, but he got transferred to the 2nd psychiatric hospital due to insurance issues.

    After he had been in the 2nd psychiatric hospital awile, he suddenly told everyone that he felt different and he thought the medication was working. He came out of his depression for the first time in many years. We all think it is the Lamictal. We are coming down off the Wellbutrin right now, and he is still on the Zoloft. We are still sorting things out.

    It is very difficult to get some psychiatrists to add a mood stabilizer unless they have tried many stimulants and/or antidepressants, and those have not worked....unless they are screaming bipolar and the psychiatrist sees it first hand. Mine tried four stimulants and 6 or more antidepressants. I have lost count of the antidepressants!

    My sons moods are now stable and he is doing very well. Many psychiatrists are afraid of the rare rash Lamictal might cause...a serious one. My difficult child never got the rash and he has no bad side effects. It does not need blood draws either, which is a plus.

    MOst of the other mood stabilizers do need blood draws and have their own side effects that need to be monitered for. My nephew does well on Tegretol. We do have bipolar on my husband's side of the family.

    I wish you luck! It might be difficult to convince them to try a mood stabilizer this soon, but I understand why you would want to. The medication rollercoster it a difficult place to be. I do hope that you get in with a great psychiatrist who you can talk to, and who will be good to work with.
  7. Alisonlg

    Alisonlg New Member

    Thanks everyone for your feedback. I truly appreciate it.

    We don't have BiPolar in our family tree that we know of, but we do have clinical Depression, which I know does up the risk a bit. My mother is clinically Depressed, as was her mother (though my mom believes there was more going on with her mom than just that, the Dr's just couldn't figure her out). Of course, I wonder if MY mother's Dr has her totally figured out too :wink: Both of my mother's parents were reportedly alcoholics. My uncle was a substance abuser and I'm SURE would have carried a diagnosis of his own had he ever seen a therapist. My aunt has Obsessive Compulsive Disorder (OCD), as does her son.

    Anyway, that's our beautiful mental history. I figure I function rather well, considering! LOL But, I still consider seeing someone myself just to pick myself apart to see if there is ANYTHING that will help my son's diagnosis, as I do see little bits of my childhood self in him. (though I was NEVER nearly that extreme) :frown:
  8. totoro

    totoro Mom? What's a GFG?

    I know how frustrating this is!!! We have the BiPolar (BP) diagnosis, not officially due to DSM criteria, but, now that we have a new psychiatrist I wonder if she has a problem with the diagnosis at such a young age??? She has mentioned trying every medication and only a Mood Stabilizer as a last resort... It makes me so angry because everyone else thinks she should be on one!!! But new psychiatrist has her on Buspar, And then said possibly an AD and then maybe something for the ADHD??? I don't like any of those ideas!

    I have the same concerns, I don't want to walk into her office acting like I know more than her!!! But you also want to make sure you are treating the right thing... try to keep an open mind, and don't feel bad if you think something is off or wrong, say something!!!

    Her pediatrician, old psychiatrist, therapist, neuro-psychiatric, Occupational Therapist (OT), us everyone is in agreement, except this new psychiatrist!!!

    Makes you want to scream!
    Sorry... hang in there.
  9. Kjs

    Kjs Guest

    Lamictal works great. difficult child does not handle change very well, and I knew we would experience some situations when I switched jobs in February. did not expect the downfall. When you are not around (working 2nd shift) then all of a sudden you are there, I seemed to have put a curve ball into their routine. Caused many arguments with husband, easy child and difficult child. difficult child made honor roll second qtr. then my job switch and he has been on a decline ever since. He told me that he thought we would be proud of him but instead we are all fighting. He was awful in school. I took him back to psychiatrist and asked about anxiety medications. OK..Lexapro..didn't work, he was awake for 4 - 5 nights. psychiatrist added Remerom to help with sleep. Did help with sleep but he has been totally out of control. went back to psychiatrist last week. took him off Remerom (lexapro removed when remerom was added). psychiatrist added Abilify. difficult child refuses to take it. husband won't push it due to side affects. So, just sticking with Lamictal. He had done so well for so long with just Lamictal.
    Takes topomax due to severe chronic headaches. Neurologist put him on that. I do not believe it is helping but difficult child swears it is. (difficult child knows that topomax is used for weight reduction also)
    I honestly believe that difficult child only says it works because he wants to lose weight. Had a complete meltdown last week because he gained 5 pounds. (remerom??)
    sorry off subject. I vote for Lamictal.