psychiatrist Apt.

Discussion in 'General Parenting' started by totoro, Apr 23, 2009.

  1. totoro

    totoro Mom? What's a GFG?

    Smallworld's comments on my Neuro-psychiatric thread made me want to post now about our psychiatrist apt yesterday.

    Our Neuro-psychiatric feels that K, once stable,she feels K is stable, could use a tiny bit of an ADHD medication.

    She feels of course that this is between us and our psychiatrist. She was highly recommended by our psychiatrist.

    We happened to have a psychiatrist apt yesterday.
    I sat and went over the last month. We have monthly apts. I usually e-mail her an update prior to the apt.
    She feels K's hallucinations are pretty much OK right now. They are not gone but they are and have never been command and are not angry anymore.
    K is dealing with them and she is able to live happily with them, they actually bring her a sense of comfort.
    The fact that hallucinations are pretty common, whether parents ever realize this or not, with BiPolar (BP) kids is what makes it easier to deal with. As far as treatment nowadays.

    K's rages are almost gone.
    psychiatrist feels she is stable in a sense that what is stable?
    husband and I can deal with her, because of how our lives are. K is not out of control.
    The only major problem now is her inability to focus and concentrate.

    So it is either wait until after School ends to try and add the Lithium. Which husband is still hesitant about because of her current weight gain.
    So we would have to add another medication on top of these 2.
    Which we are trying to avoid.
    psychiatrist read the Report and said what do I think about the ADHD medication?

    I said in the past I would have flat out said NO.
    I asked her what she thought.
    She agreed, but with how stable K has been, she said it might not be the worst to try a tiny amount of Focalin on a weekend and just see how she responds?
    We would know right away and could stop if it went wonky.

    She was kind of back and forth.
    I couldn't get a read on her true feelings. I asked her what she would do?
    She just said, "Well you can try it"


    She then told me all about the reports on how kids who are stable...blah blah blah.
    She also went into all of the details about the differences between the chemical makeup of Ritalin and Focalin.

    In the end she left it up to husband and me.

    I know, she is not on a MS.
    I just want the answers and I want no medications at all...

    The kid can't sit still.
    She can't watch TV and talk to you, I have to actually turn off the TV to ask her a question.
     
  2. busywend

    busywend Well-Known Member Staff Member

    It became obvious to me that my difficult child needed to take a stimulant when:

    1.) she was losing what few friends she had due to her behavior.
    2.) she was dropping grades like crazy (Bs to Ds) as the work got harder.
    3.) she felt different because she could not be like the other kids.

    Now she feels different because she takes medication - so 6 of one and half dozen of the other on #3.

    You have to weight her quality of life. She may not need stims yet. It might become more apparent to you in a few years. Or not. She may with time learn skills to cope or change her own behavior.
     
  3. totoro

    totoro Mom? What's a GFG?

    Hmm,
    BW, I see all of those things, but I would think oh her grades or school work is getting worse because of cognitive dulling, or something! I just never thought about it! Why... LOL

    I keep asking why she is becoming socially more immature and having a harder and harder time making friends and feeling worse about herself as far as friends.

    I just don't know, we have been working on all of these thing for years now and it just never seems to get any better, just worse.
    Her mood is better though just none of the other junk... sigh what to do.
    I just don't want to continue moving backward.
     
  4. DammitJanet

    DammitJanet Well-Known Member Staff Member

    K is on abilify right? That is weight neutral. Give me a rundown on what MS she has been on and the effects. I really cant remember. Sorry...too many kiddo's on the board...lol.
     
  5. smallworld

    smallworld Moderator

    The Treatment Guidelines
    http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf

    Not sitting still and not being able to concentrate can be a sx of mania or even anxiety. I personally would not recommend trying a stimulant without a mood stabilizer on board.

    All three of my children have at various times been diagnosed with inattentive ADHD by neuropsychs, but in watching and treating them over the years, we don't think they actually have it. We think their mood disorders have fueled their inattention.

    My son took Focalin for quite a while and did OK, but in the end we decided to discontinue it because it made his mood fluctuate over the course of the day as it took effect and then wore off. My daughter A took Focalin for two days, but it made her irritable and depressed, and she begged us to take her off it.

    The social immaturity, difficulty with making friends and increasing challenges with schoolwork are more likely due to NonVerbal Learning Disorder (NVLD) than anything else. It's a Spectrumish disorder.

    Obviously, we're not doctors, but my own personal feeling is to be very cautious about introducing stimulants in K's case.
     
  6. totoro

    totoro Mom? What's a GFG?

    This is why I come here to bounce things and thought off of. I know all of these things and the guidelines...
    But you know how it is?
    I mean even you have tried them SM, I think I get caught up in trying to just "fix" her which I know I can't.
    I just want it to be easy.
    Then there is part of me that thinks, what if it did actually help? It just might, because none of this really is exact science...


    Janet,
    The MS's she has been on...

    Trileptal- horrible stomach pains, so bad we had to Difficult Child before we could even get it up to therapeutic levels.

    Lamictal- which i actually liked but we Difficult Child'd it because we did not have psychiatrist. psychiatrist is not so sure about re-starting this medication. Even though I am taking this.

    Topamax- not sure about this, she was on a bunch of other medications so not sure if it helped or not?

    Depakote- Triggered her badly. Rages, violent, delusional.

    psychiatrist wants to put her on Lithium, but we are waiting until we can get K to start drinking more water. She has been dehydrated a few times since moving here.
    It has been in the upper 90's already.

    None of the AP's have been weight neutral for K. She is borderline obese right now. Even her psychiatrist is concerned.
    It is not an option in my mind to let my child become obese due to a medication.
    She is already asking me if she is fat, she is 7.
    She is already dealing with depression and anxiety. So... what to do???

    I may write her psychiatrist.
    You guys make sense and confuse me more!!!
     
  7. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Ok...do you want my two cents and completely unprofessional and unsolicited opinion which is worth exactly what you are paying for it?

    If this were my child, I would be staying on the abilify because she does have the hallucinations and she needs an AP. I would not use lithium but I would pester the psychiatrist for both lamictal and topamax. If you can get her finally stable at some point on the above medications then maybe someday you try a very low dose of say either focalin or maybe even wellbutrin for the attention symptoms.

    K seems to take after her Mommy and her Auntie J. LOL. Maybe she just needs the same medications we take.
     
  8. Momslittleangels

    Momslittleangels New Member

    Just curious - - I have a family member who has ADHD and when he drinks an energy drink, he is more focused. I know that there is A LOT of sugar and caffeine in those things, but is it worse for you than the actual stimulants? I wonder if there have been any studies on that.

    I was thinking that maybe she could try one energy drink and see if it helps counter the ADHD (please don't judge if you completely disagree - I am speaking from an ignorant standpoint of the down side of energy drinks). In essence, you are really trading one drug for another, but is one worse than the other??
     
  9. totoro

    totoro Mom? What's a GFG?

    You know Janet... I do love you opinion!!!
    I have asked and kind of pushed for this combo... she was on the Abilify/Lamictal combo and did really well. But this was stopped when we had no psychiatrist.

    I really love our psychiatrist. I just think she sees that we have tried it and that means it is crossed off of the list, you know?

    Or maybe she personally just doesn't like Lamictal. LOL

    I just sent her an e-mail listing all of my concerns. Told her I had a long night and read too much and talked to some of my friends and now I am freaking out!
     
  10. jannie

    jannie trying to survive....

    Hi Smallworld....can you summarize the article for us (LOL). I'm too tired to read all of those pages...

    Regarding trying the stimlulant....I thought that kids who have mood disorders can often react negatively when given stimulants and become more irritable and possibly aggressive (this happened to my difficult child 1)...but at least the stimulant is out of your system within a few hours. On three different occasions I tried a stimulant for my difficult child and all three times he presented with negative side effects...therefore it is not for him.

    My other child is on lamictal and a stimulant and it seems to work...

    I do wonder with summer coming if you can hold off on the stimulant and get the ms on board and by the time school starts you may be able to give it a try??

    I wonder if it's possible to trial the stimulant for just a few days to know if you possibly see benefit...and then make the decision about continuing or trying to get her more stable.

    Lots of decisions; no real answers.....I'm really GLAD to hear she has been doing well over the past couple of weeks !!!
     
  11. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Well....you are the mom and can get a bit more pushy if you want to...lol. I really would want to try the lamictal again before going to lithium because of the water and weight issues. Also...isnt there some question with K about if this could be seizure related? Of course, I am of the mind that bipolar and seizures are related anyway. Just ask my poor brain after I was abruptly withdrawn from my medications last fall....seizure city! Im still not quite right.

    I dont want to go into a tirade on my opinion about what bipolar is or isnt...you dont need all that...lol.
     
  12. jannie

    jannie trying to survive....

    Actually my lamictal/abilify child is much calmer and better focused than my lamictal/vyvanse child....

    Lamictal has been a good thing for us....and with very few side effects...
     
  13. totoro

    totoro Mom? What's a GFG?

    Seizures were rule out. But we know how that is.

    I know I can be pushy, I just get so tired of being the B#*$( Mom who is, well you all know.
    I am not fully anti ADHD medications, but I am in agreement with SW and Janet that she likely doesn't need one right now.

    I do believe that some people who BiPolar (BP) are able to take a tiny amount of a stimulant and it helps. This is proven...

    But you know how it is. I get excited and think, what if?
    I don't think I will do it. I will likely wait the 4 weeks until School is out and then go from there. Our next psychiatrist apt is the last day of School.

    I will make husband go and School him on the medications and what WE want.
    Our psychiatrist is not a true believer in the ADHD as a separate diagnosis.
    She feels most things are a symptom of the BiPolar (BP).
    On the other hand, the Nuero-psychiatric feels they are truly co-morbid disorders.

    So I am not going to get into that argument with the both of them! LOL

    I am alos afraid the kid is going to drive me crazy this summer. You can't slow her down, on the weekends, it is misery.

    We run her butt off and she still goes even when she is exhausted.
    But I don't want her zonked out.

    Thanks ladies, nowhere else could I have bounced these thoughts around and really cleared my head.

    Love you guys!!!
     
  14. Wiped Out

    Wiped Out Well-Known Member Staff Member

    My difficult child was off the chart hyper without medications. The thing is he cannot take any stimulants-a lot would have to happen for me to be willing to have him try them again. He just rages way too much on stims. Last summer someone at camp gave him the wrong medications (a stimulant) and that night we got a hole in our bedroom door.

    He now takes 1/2 clonidine in the a.m and 1/2 at around to help with the ADHD part of things. we didn't know how much it was helping with the hyperactivity until he was in the hospital last year and they tried to take him off it. No one could believe how hyper he was!

    I hope you are able to find something that will work for K. Hugs.
     
  15. Jena

    Jena New Member

    hey i'm sorry i'm so late to this.

    it's such a process isn't it? i know it stinks. I kinda like Janet's thoughts on the medications also.

    I"m sorry I know it's so confusing. I have to do the same with-difficult child i shut the t.v. off if i need to speak to her and she's infront of it.

    hang in there (((Hugs)))
     
  16. Wiped Out

    Wiped Out Well-Known Member Staff Member

    One more thing about the Lithium. difficult child never drank water before he was on Lithium. After he started the Lithium he couldn't stop drinking water (until he stopped taking the Lithium).
     
  17. pepperidge

    pepperidge New Member

    Totoro,\\My oldest has high anxiety, a lot of issues of copying off board etc. combined with what appears to be a strong tendency towards depression, has responded really well to Lamictal.

    The first medication he was put on (other than Lexapro which was a total disaster immediately) was a small dose of Adderall. It helped both school functioning,compliance and mood. It still has a major impact to this day. However, we found that we really needed to add a small dose of Risperdal to even out some of his mood and anxiety issues..

    I don't know if my son truly has ADHD. All I know is that the two medications that have helped him the most have been lamictal and Adderall.

    My younger son who has more classic type of ADHD symptons did very poorly on Ritalin, Focalin and Adderall. It made him hyper anxious and increased his obsession with things. It was one of those things where we knew within the first day and certainly by the second that these were not the medications for him. Am I sorry we tried? No. He still needs something, but his brain chemistry is just pretty complicated.

    Since you have abilify in place I would not automatically discount a very short trial (day or two) of a very small dose of Focalin or something similar. You will know I think pretty quickly if it has a bad side effect. You may get no effect, which might be good, might indicate to try a slightly higher dose.

    I guess a question to ask your psychiatrist is since you have a AP in place, if you try a very small dose for a day or two, whati s the likelihood that there would be an irreversible bad side effect? Also suggest if you try a stimulant, try the short acting kind. If you see good things but a deterioration in behavior as it wears off, you might want then to think about longer acting medications.

    In any event I would not automatically discount the stimulant. My child would not be getting through school - despite being quite bright--without it.

    P.
     
  18. smallworld

    smallworld Moderator

    Toto, I should point out that J took stimulants in 4th and 5th grades before we knew he had a mood disorder. Over time stimulants depressed him, and he begged us to take him off in 6th grade so he would feel less "flat."

    A took her two days of Focalin for a concussion that was making her very sleepy. Our neuro thought it would help wake up her brain. But she hated the way Focalin affected her mood and asked to discontinue.

    You should also be aware that stimulants can cause hallucinations. You might want to ask your psychiatrist about that.
     
  19. ML

    ML Guest

    I think you are a true warrior mom. You *have* to be pushy in that role. You are doing a great job wm xo :) ML
     
  20. crazymama30

    crazymama30 Active Member

    FWIW, my difficult child does horrible on stims without a mood stabizer, but he does bad on a mood stabilizer alone. He is a completely different kid than K. He did ok on Focalin, but does great on Daytrana. I think it is the controlled release that does it.

    I do agree with Janet about the abilify. If she has hallucinations why do they want to take her off of it? Or do they? I have also seen the Lamictal/abilify combo do wonders for husband, but he will be going to something different due to tardive.
     
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