Medication Crossroad? Any thoughts/experience?

Discussion in 'General Parenting' started by jal, Dec 11, 2008.

  1. jal

    jal Member

    difficult child's psychiatrist is wanting to try another d**n medication. psychiatrist absolutely believes that difficult child is bipolar and ADHD. Now I had a neuropsychologist done at an early age and it agreed with a mood disorder. Even though it was independent, I don't think it was as thorough and again he was young. He saw a pediatrician neuro at an early age that said he was definately ADHD, so did the other psychiatrist we had before this one. His 3 weeks stint in psychiatric hospital agreed with mood not otherwise specified and ADHD.....yet....I could buy the ADHD if the kid could repsond to a stimulant, but THIS KID DOES NOT RESPOND TO A STIMULANT AND WE HAVE TRIED WELL OVER 13!

    Metadate
    Ritalin
    Ritalin XR
    Adderall
    Adderal XR
    Clonidine
    Gaufacine
    Straterra/Tenex Combo
    Daytrana Patch
    Vyvanse
    Focalin
    Dexedrine and a few more I can't recall. Even was on a antidepressant nortriptaline which seemed to work after coming home from psychiatric hospital, but he began to itch so from it, so it has been d/c.

    Now psychiatrist wants to try Wellbutrin. difficult child is only on Seroquel and we are working up to 300mg/per day (he is currently at 250mg). New therapeutic school first thought they saw Pervasive Developmental Disorder (PDD) as did new in home intensive services. We are going to be asking the new school to do another neuropsychologist. That meeting is Monday. I have an evaluation appointment set up with the agency's psychiatrist and I have scheduled a 3 visit evaluation with a psychiatrist who is very well schooled in Pervasive Developmental Disorder (PDD) and autism.

    husband will have a fit about another medication, but difficult child really needs to be brought down a bit. Very hyper, spinning, loud. difficult child has was also on a yr long regime of Depakote, Abilify, Straterra and Tenex with-no marked improvement.

    I am so frustrated, I just want to know what is really going on with-my kid and I hate throwing these medications at him-he's 6 for pete's sake! Any thoughts?
     
  2. Shari

    Shari IsItFridayYet?

    No, but I'm with you. I don't believe my difficult child's docs know what they are dealing with, either, yet they want to throw medications right and left.

    I'm outright refusing additional medications until they can convince me that they have a clue what they are treating. I know there are therapies and training they are not giving him because 1 member of his team does not beleive he has a spectrum disorder, and frankly, til they convince me that his "symptoms" ARE caused by these other diagnosis'es, I am not gonna medicate to mask symptoms; not when there is other help available that they aren't willing to try.
     
  3. Jena

    Jena New Member

    hi

    i just wanted to jump in and offer you some support and say ive been there as well with the medication game, recently infact. It wasn't until I recvd. great support in here that i was able to break thru my wall and try another medication.

    So, even on the amt of seroquel he's still jumping around a whole lot, huh..?? Do you see any anger outbursts, violent stuff at all, easily aggitated? Sorry I dont' remember the back ground stuff from other posts. I can barely remember yesterday lol.

    My daughter was also diagnosis with adhd, Obsessive Compulsive Disorder (OCD), depression and bipolar their assuming at this point and anxiety disorder. It gets complicated with the medications. My daughter didn't respond to any antidepressants, or any anxiety medications at all. We never tried a mood stabilizer, we decided to go with seroquel. so far, so good. we are only on 75mg. she still has breakthru sleepless nights she seems to be cycling right now.

    So, the doctor right now is wanting to add welbutrin to the seroquel?? He doesn't want to go any higher on the seroquel first?? Also i was just wondering after he tapered off the other medications, did his body have a change to stabilize to no medications before adding the seroquel in?? Sorry I'm just shooting out thoughts.

    I"m also hesitant with medications and with doctors. I always question as you do and thats a good thing because it sounds like your a great advocate for your child. I dont' think they know either, to be honest. It's like the process of elimination. Nothing is tested on children, so with that being said they just go with what they know from past experience with i guess treating their other patients.

    is he in therapy also?? i think it's a combined effort, the therapy with the medications, and the school and us! sheesh it takes a village, right??

    (((hugs)))
     
  4. jal

    jal Member

    It does take a village!

    difficult child is in out of district placement at a therpeutic school, we also have intensive in home therapy for him 2x a week. We did a medication was with difficult child which resulted in a 3 week psychiatric hospital stay this past summer. Since then difficult child was placed on Seroquel and Nortriptaline. We took off the Nortiptaline and he has been off that medication for 3 weeks now, so it is out of his system. Serouquels therapeutic level is 800mg and difficult child is only 6, so we are approaching that cautiously.

    The thing is difficult child has no trouble sleeping through the night, does not get depressed, but has low frustration levels, can have violent/physical outbursts and seem to listen at all or respond if engrossed in something else.

    Last night with-in home therapy he was bouncing around once the team arrived (somehwat normal 6 yr old showoff behavior). husband and I retreated downstairs as they wanted to worked on creating rules for him when they come to our home. difficult child is bouncing up and down, writhing all over the couch as they try to engage him. He goes to hide, moves a chair an starts to step on the banister railing. I had to get him down, then talk to him and redirect, which workd (they thought I had done it well-Sure. Only for how long in his life so far have I had the practice!)

    Then he settled and did some work, then once we were invited to join it all started again. I mean I agree he needs to be brought down a bit (even very hyper in school), but I am so tired of the medication merry go round.

    Thanks for everyone's input!
     
  5. smallworld

    smallworld Moderator

    Was the itching definitely from the Nortriptyline?

    Seroquel is dosed by clinical response, not by a "number." However, 800 mg is typically the highest dose most psychiatrists feel comfortable going, although I've heard of some going as high as 1200 mg in cases of extreme mania or psychosis (it's unusual). My son is currently taking 600 mg with good results (he was at a high of 800 mg, but we've been able to reduce it over time). He was prescribed Seroquel a year ago for anxiety, depression and sleep problems. Over time, your difficult child could settle down on Seroquel, but it would have to be at the right dose.

    I'm a little confused by your psychiatrist's decision to trial Wellbutrin. It's a stimulatory antidepressant, and our psychiatrist is thinking about rxing it for our son because he seems shut down, not wound up. Wellbutrin is on occasion rxed for ADHD, but it is generally used for inattention, not hyperactivity. Did your psychiatrist say why he chose Wellbutrin?

    by the way, kids can have both Pervasive Developmental Disorder (PDD) and mood disorders. According to The Bipolar Child, estimates for co-morbidity are in the 10 to 35 percent range.
     
  6. Shari

    Shari IsItFridayYet?

    Thanks for THAT info. difficult child's doctor is pushing Welbutrin right now. He has had nothing but negative reactions to stims.
     
  7. Our psychiatrist tried Wellbutrin with my son last year in addition to the seroquel he was already on, it made him worse. He was ready to explode.
     
  8. GoingNorth

    GoingNorth Crazy Cat Lady

    I'm on the spectrum as well as BPII.

    Welbutrin turned me into a ball of reactive nerves.

    Late husband was ADD (not ADHD) and found that all Welbutrin did was make him exceedingly nervous (could not tolerate stims).
     
  9. Bugsy

    Bugsy New Member

    I have not been on the boards much at all, so I am sorry if this question has been posed already but have you tried lithium? My son went through all of the medications you listed and then some, but the first thing that helped and he's doing great with (knock on wood) is lithium. Once he was more stable on lithium then we were able to very slowly add a stimulant. We tried tons of stimulants prior to the lithium with horrible/scary reactions but now he does well with concerta and a small dose of ritalin in the afternoon.

    I relate to the frustration. It took us 4 years to get to where we are now. He made honor roll every progress report so far this year I don't know what tomorrow will be but today I can tell you it is possible to find the right combination. Good luck
     
  10. jal

    jal Member

    The psychiatrist wants to try Wellbutrin to work on ADHD. Bugsy-yes, we tried Lithium with no luck. I am just not feeling the BiPolar (BP) diagnosis. Some things fit such as mood, but not the highs and lows. As you can see from our stimulant list nothing is working.

    I messaged the psychiatrist that we will not try Wellbutrin as husband's aunt (who is bipolar) had a psychotic breakdown from Zyban which is Buproprion and is Wellbutrin. So I guess we go into a holding pattern.
     
  11. gcvmom

    gcvmom Here we go again!

    Although my difficult child is older (12), he stopped responding to stimulants as well a few years ago. At first they acted like water. Then they made him hypomanic and jittery.

    He still needs the stimulant though (or so we think) and now only takes about 5mg Daytrana. He now takes a total of 1100mg Seroquel XR per day -- 700mg at night and 400mg at lunchtime. It took about four months to titrate up to this level. The psychiatrist says this is a fairly high dose, but he says he has to go more by response than by a number. It actually has helped his ADHD symptoms, and it also helps with his anger and frustration. He's not COMPLETLY stable yet, but he's in a much better place than he was last Spring.

    The search for the right medications is a very long and frustrating road for these kids. You really cannot predict easily how they're going to respond to one medication or another until you give it a trial run.

    As parents, we have to weigh what we know intuitively about our kids with the advice and experience our psychiatrists to make our decisions, and even then it feels like a leap of faith!
     
  12. totoro

    totoro Mom? What's a GFG?

    K was first diagnosis'd with ADHD and ODD... the ODD was taken off and the ADHD should be taken off. The psychiatrist's all feel now like K has *symptoms* off ADHD and they are worse when she is unstable... her first psychiatrist truly feels like most of the co-morbid symptoms when you are dealing with Mental Illness are just that *Symptoms*.
    She does think that kids can have a true separate diagnosis of other conditions like Pervasive Developmental Disorder (PDD)-not otherwise specified, but things like ADHD or Generalized Anxiety Disorder (GAD)... a lot of times are just symptoms of the Mood-Disorder.
    So when you have the Mood-Disorder under control the other symptoms go away or lessen. Then in theory you would medicate with a smaller dose, the leftover symptoms. Once the child was stable on the Mood Stabilizer.

    Sounds easy! But finding the right MS is the tricky part. Being patient, the psychiatrist's being patient, everyone! Is so hard... During it all our kids suffer...
    K has been on 18 medications... she will start her 19 in January.
    We had psychiatrist who kept trying to treat her ADHD... he ignored her BiPolar (BP).
    She got worse.
    I don't know your full history or all the details. But we are pretty confidant that K has BiPolar (BP). She doesn't always stay up all night especially when on medications.
    BiPolar (BP) is a Spectrum just like all other Disorders. Staying up all night would not rule it in or out.
    I am on medications have been for years, but I am still trying to find the right balance.
    I just had to do 3 changes in the last 4 months.
    I know this is so frustrating.
    If you honestly do not feel he has a Mood Disorder, I would seek a new Nuero-psychiatric evaluation.
    Our kids do change so much over the years...
    I hate this and the medication-merry-go-round as well...
     
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