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<blockquote data-quote="Sara PA" data-source="post: 176263" data-attributes="member: 1498"><p>I've been thinking about your situation and started pulling some old anecdotal information out of the back drawers of the filing cabinet in my brain. </p><p></p><p>Do you know that Lamictal is a mood stabilizer approved to treat bipolar in people over 18? As is common in our health system, once a drug is approved for an indication for one age group it is almost immediately prescribed for that indication for all age groups. Even before Lamictal was officially approved for use as a mood stabilizer, it was being trailed based on favorable reports presented at medical conventions. And it was occaisionally and cautiously being prescribed for children for whom nothing else seemed to work.</p><p></p><p>Almost immediately parents reported that Lamictal was "activating" for some children. I did notice at the time that Lamictal was often the second mood stabilizer for most of those children and it was usually added to Trileptal. These drugs along with Neurontin were favored for kids because they don't require blood draws. "Activating" means that the drug induced mania, in bipolar parlance. Because the Lamictal was then prescribed for bipolar just like it was for epilepsy, the drug was administered twice a day and kids were taking it before bedtime. Inability to sleep = mania in the bipolar world. Now I'm wonder if maybe it wasn't the Trileptal/Lamictal combo, maybe it wasn't mania, maybe it was an adverse reaction. Maybe it was all of those things coming together.</p><p></p><p>Neurontin (gabapentin) was widely prescribed for bipolar at the time even thought there wasn't one iota of clinical research to support the use. Turns out its use for bipolar and 10 (IIRC) other indications was all lies, for which the manufacturer paid a heavy price. While is was still suppose to be the biggest new wonder drug since aspirin, parents reported that it was "like giving them water" or worse -- sometimes a child's behavior deteriorated. A search through the epilepsy literature turned up the information that gabapentin causes aggressive and hostile behavior in children. </p><p></p><p>For a long time, Lamictal wasn't prescribed much for children, then children under 12, then under 6 because of the now controversial belief that it was more likely than other anticonvulsants to cause Stevens-Johnson. So even anecdotal information was scarce, at least on the various mood disorder boards.</p><p></p><p>Now I'm beginning to wonder if the Lamictal does cause psychiatric side effects which make its use for children problematic. It absolutely can cause sleeplessness. Maybe, like gabapentin, it can cause aggression/hostility. Maybe like I saw in my son (who was 15 years older than your child) it can cause anxiety. I think you have to consider the possibility. And, if that's the case, I doubt that any behavior modification program or the addition of any other drug will result in a satisfactory outcome.</p><p></p><p>It breaks my heart to write this. I know Lamictal is a great anticonvulsant and is the mood stabilizer of choice for teenagers. We thought it was our son's one miracle drug. Putting all the pieces together, now I'm not so sure. </p><p></p><p>And it saddens me to suggest this to you because of the positive results you've seen for seizure control. If Lamictal has these psychiatric side effects, it puts you between a rock and a hard place.</p></blockquote><p></p>
[QUOTE="Sara PA, post: 176263, member: 1498"] I've been thinking about your situation and started pulling some old anecdotal information out of the back drawers of the filing cabinet in my brain. Do you know that Lamictal is a mood stabilizer approved to treat bipolar in people over 18? As is common in our health system, once a drug is approved for an indication for one age group it is almost immediately prescribed for that indication for all age groups. Even before Lamictal was officially approved for use as a mood stabilizer, it was being trailed based on favorable reports presented at medical conventions. And it was occaisionally and cautiously being prescribed for children for whom nothing else seemed to work. Almost immediately parents reported that Lamictal was "activating" for some children. I did notice at the time that Lamictal was often the second mood stabilizer for most of those children and it was usually added to Trileptal. These drugs along with Neurontin were favored for kids because they don't require blood draws. "Activating" means that the drug induced mania, in bipolar parlance. Because the Lamictal was then prescribed for bipolar just like it was for epilepsy, the drug was administered twice a day and kids were taking it before bedtime. Inability to sleep = mania in the bipolar world. Now I'm wonder if maybe it wasn't the Trileptal/Lamictal combo, maybe it wasn't mania, maybe it was an adverse reaction. Maybe it was all of those things coming together. Neurontin (gabapentin) was widely prescribed for bipolar at the time even thought there wasn't one iota of clinical research to support the use. Turns out its use for bipolar and 10 (IIRC) other indications was all lies, for which the manufacturer paid a heavy price. While is was still suppose to be the biggest new wonder drug since aspirin, parents reported that it was "like giving them water" or worse -- sometimes a child's behavior deteriorated. A search through the epilepsy literature turned up the information that gabapentin causes aggressive and hostile behavior in children. For a long time, Lamictal wasn't prescribed much for children, then children under 12, then under 6 because of the now controversial belief that it was more likely than other anticonvulsants to cause Stevens-Johnson. So even anecdotal information was scarce, at least on the various mood disorder boards. Now I'm beginning to wonder if the Lamictal does cause psychiatric side effects which make its use for children problematic. It absolutely can cause sleeplessness. Maybe, like gabapentin, it can cause aggression/hostility. Maybe like I saw in my son (who was 15 years older than your child) it can cause anxiety. I think you have to consider the possibility. And, if that's the case, I doubt that any behavior modification program or the addition of any other drug will result in a satisfactory outcome. It breaks my heart to write this. I know Lamictal is a great anticonvulsant and is the mood stabilizer of choice for teenagers. We thought it was our son's one miracle drug. Putting all the pieces together, now I'm not so sure. And it saddens me to suggest this to you because of the positive results you've seen for seizure control. If Lamictal has these psychiatric side effects, it puts you between a rock and a hard place. [/QUOTE]
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