My Son is still in a manic state after stopping the Zoloft - Dr. suggests Lamactil?

Discussion in 'General Parenting' started by cassiemoun, Apr 29, 2011.

  1. cassiemoun

    cassiemoun New Member

    I have no idea what is the right thing to do. We're scheduled for the UCLA neuro-psychiatric testing in June (hopeffuly sooner, I am calling weekly). Our son has now been off the Zoloft for 2 weeks. He is still much more aggressive, confrontational, active, and defiant.

    He's not having super intense rages, but when they are bad, they are still much worse than before. His ADHD Doctor is suggesting we try Lamactil with him.

    I don't know if it's a good idea for him to be on something like that for the neure-psychiatric testing. It's 3 seperate appointments and will cost $3000, so I really need for it to be accurate.

    We did meet yesterday with- a p-doctor to begin in-home ABA therapy. I am very excited about how they can help our son (and entire family).

    What do you think about the medications? Is Lamactil appropriate for mania/aggression?
    I don't see any depression at all.
  2. shellyd67

    shellyd67 Active Member

    I am no expert on these medications (or any for that matter) just stopping in for support. I hope things even out...
  3. HaoZi

    HaoZi Guest

    Kiddo was still escalating her risperdal-induced aggression weeks after she stopped taking it. It took finding another atypical AP to help her start to calm down. The one that helped after that was Zyprexa, which had to be stopped later due to other reasons.
  4. Steely

    Steely Active Member

    I am not exactly sure what to tell you either, other than Lamictal seems to really have helped Matt. He was always more manic than depressed, yet sometimes things can be masked with bi-polar and not seem what they exactly are. in my opinion I would go ahead and try it. I do not think the NeuroPysch exams will be compromised. Matt had his tests while on 4 different medications - the basis of the brain is still operating the same way - it is just that the medications calm it down a bit.
  5. smallworld

    smallworld Moderator

    I think you should call the UCLA neuropsychologist's office on Monday and ask about starting a medication before the testing. They will be able to advise you about whether the testing will be affected by the medication.

    Lamictal can help with emotional reactivity and general mood stabilization, but its most common use is bipolar depression. It also has a very slow titration because of the risk of a serious rash called Stevens-Johnson Syndrome (the slower you increase the dose, the lower the risk of the rash). For this reason, it's not a great choice when you're trying to stop mania in its tracks. Atypical antipsychotics are generally the medications that are chosen for acute mania because they work quickly. Anticonvulsant/mood stabilizers like Lamictal are often added later on for long-term mood stabilization.
  6. rlsnights

    rlsnights New Member

    That's the Kaiser psychiatrist recommending lamictal?

    I think that it's more important to try to get him stabilized than to worry about the appointment in June. A big part of the assessment of a younger child is the history - what the parents tell them. If you keep good records to give to them in June you will do yourself and your son a huge favor. If you want more advice about that just say.

    I'm not a doctor but I am wondering why the doctor isn't suggesting either an atypical antipsychotic (now considered first line treatment for early onset bipolar) or lithium (a first line treatment for mania). These medications often work pretty quickly - generally more quickly than a mood stabilizer like Lamictal.

    I would try to get the psychiatrist to talk about all the medication options for treating his current symptoms and exactly why he is recommending this particular one over the others.

    I'm sorry that your son is going through this. It must be very scary for him.

  7. JJJ

    JJJ Active Member

    I agree with Smallworld. Even if you start the Lamictal tomorrow, it is doubtful that he'd be at a therapuetic level by June. I would ask the doctor for something with a more immediate impact.
  8. smallworld

    smallworld Moderator

    A big part of a neuropsychologist evaluation is not history, but actual paper and pencil cognitive testing. So having a medication on board or not may affect the testing. That's why a call to the UCLA neuropsychologist office on Monday will answer the question of whether the medication should be started prior to the testing.
  9. crazymama30

    crazymama30 Active Member

    You have gotten very good advice here, I would definately call Monday and ask the neuropsychologist office what they think. Hugs to all of you, sounds like things are hard.
  10. Jena

    Jena New Member


    yes i agree also...... we just began lamictal and it's activating my little girl somewhat and to decrease a hypomanic phase you dont want to use that...... an ap is much better.....

    good luck either way and good luck with the testing i agree to contact facility first also.
  11. rlsnights

    rlsnights New Member

    It's not a bad idea to call and try to talk to the neuropsychologist people about changing his medications.

    However, if your son is unable to sit still, concentrate, cooperate with lengthy testing periods (1+ hours), in general function at least well enough to make a reasonably sustained attempt at the pencil/paper cognitive parts of the assessment and to cooperate with any other kinds of testing/assessment the neuropsychologist people want to do - that may be a problem.

    If you doubt his ability to cooperate with the assessment process, then I think you should ask the neuropsychologist people about that in the same conversation as you talk with them about changing his medications.

    I wonder if they will think it's better to change medications now than to do it a week or a few days before the scheduled appointments should his behavior/mood worsen. Gives time for him to react to the medication before they see him.

    Hopefully they won't put it back onto your current psychiatrist to either contact them or figure it out.

  12. cassiemoun

    cassiemoun New Member

    Thank you all. I am somewhat an expert on ADHD medications, but have not a clue when it comes to mood disorder medications. I will ask the Dr. about AP's. Is Lithium an AP? I think I'm going to contact a Kaiser psychiatrist we saw about a year ago and see what she'd reccommend. Currently, his Rx doctor is a pediatrician that heads the ADHD clinic. I don't think he's very educated about mood stabilizers vs. AP's.

    Thanks again for both the advice and support. It's a lonely road, having a child like this, and you all are the only people that can possibily understand.
  13. smallworld

    smallworld Moderator

    Lithium is a mood stabilizer that is the gold standard for treating adult bipolar disorder. Some pediatric psychiatrists don't like to use it for children because of the side effects; some pediatric psychiatrists will use it for children. It's probably 50-50. It requires blood draws to monitor levels in the blood stream.
  14. rlsnights

    rlsnights New Member

    I think I should have been clearer in my earlier post. And mention that these suggestions are based on my personal experiences and may or may not apply to your situation.

    I am not trying to say that your son is or is not bipolar.

    The medications I mentioned (you should absolutely be talking to the psychiatrist NOT the pediatrician, in my humble opinion) are often effective in treating agitation and/or the kind of energized behavior (both the "happy" kind and the angry/reckless kind) that comes with imbalances in the neurotransmitters in the brain.

    It sounds like he has had a reaction to the SSRI and needs his brain "calmed down", for lack of a better analogy.

    This may be a temporary situation - or not. Only time is likely to tell - and perhaps a long time.

    The reason I mentioned Lithium is because it usually has a very rapid impact on manic-like behaviors. As with all medications, there are side effects and drawbacks to it's use. Lamictal comes with a risk of rashes that (very rarely) can develop into a serious life threatening infection and typically is not effective until you have reached therapeutic levels - which can take several weeks because dose increases are done relatively slowly. Depakote, another commonly used mood stabilizer, also needs regular blood draws if the psychiatrist is doing things the "right" way and is associated with weight gain.

    And all of that is without considering the interaction between any other medications he might be on in addition to the psychiatric medications.

    This is why a psychiatrist, preferably a child psychiatrist, needs to be overseeing your son's care - in my opinion.

    The one time we got good mental health care for my son at the Kaiser here was when he really deteriorated and had to be hospitalized. When he was released we got intensive services with a social worker/therapist who saw my son at twice a week, saw me at least once a week and was available by phone for support M-F and access to an after hours crisis service. This lasted for about two months. Then we were supposed to go back to the regular services - which meant seeing a therapist once every 3-4 weeks and a 10 minute psychiatrist appointment once a month. An all or nothing approach.

    So you may want to think about taking him to ER when his behavior is really agitated and energized and dangerous to himself/others. It may get you more intensive support during this period.

  15. cassiemoun

    cassiemoun New Member

    I would like a doctor be able to tell me (or at least find some research on my own) if the fact that he is still affected, means he is bipolar. Going on my gut feelings, I think he has Aspergers, not a mood disorder, but I could be wrong of course. The analogy that his brain is still recovering makes logical sense, I'd just like to see what the research says about it.

    When he was in serious crisis from the reaction to the Zoloft (which, by the way, he was a 10 on a scale of 1-10 then - now he's more like a 5 and before all this SSRI reaction, he was a 3 - just to give some prespective). We did bring him to the ER. The only thing they would offer is inpatient down in Torrance, CA - about 1-1/2 minimum from our home.

    When your son was hospitalized, was it a Kaiser hospital? I tried to get them to send him to UCLA, but they said UCLA wasn't one of their contracted hospitals.

    I think I need different insurance...but it's scary to think about switching healthcare insurance in this time of crisis.

    I really appreciate your thoughts and experiences! Thank you.

    I understand what you are saying.
  16. rlsnights

    rlsnights New Member

    Fairly recent research into conditions that are co-morbid to Aspergers found that 74% of the kids they looked at had co-morbid diagnoses including major mental illness, anxiety, behavioral (ODD), ADHD.

    Here's an article from Medscape that talks about comorbid conditions. You have to register for Medscape but it is free and you won't get any spam.

    It's not as recent as other research but it's a good place to start. You can explore Medscape for more info on Autism.

  17. smallworld

    smallworld Moderator

    My own son was diagnosed with mild Pervasive Developmental Disorder (PDD) (Autism spectrum, but not meeting full Aspergers criteria) last May after more than 30 medication trials since age 9 and during a 16-month Residential Treatment Center (RTC) stay. It was not for lack of trying to get at the bottom of what was going on with him, but the doctors who saw him over the years agree that he was a complicated case. We now know that the umbrella diagnosis is Pervasive Developmental Disorder (PDD), but he certainly does have anxiety and mood dysregulation issues. What I have since learned from several psychiatrists is that kids on the spectrum tend to be extremely medication-sensitive and have a lot of unusual medication reactions. That certainly was the case for my son, and for a time that led us down the bipolar path (which he doesn't have). What I've also learned is that kids on the spectrum in general respond positively to stimulants for ADHD symptoms and atypical antipsychotics for aggression and agitation and negatively or not at all to mood stabilizers and SSRI antidepressants. Just something to keep in mind as you go along on your diagnostic journey.