Rages,violence,depression???

Discussion in 'General Parenting' started by totoro, Sep 16, 2007.

  1. totoro

    totoro Mom? What's a GFG?

    Big Sigh...
    So we had the honeymoon back from the psychiatric hospital at the beggining of Aug, she was released Aug 3rd... did well for about 2 weeks... then started getting violent again. I thought the Strattera was causing some of the increase... loss of full day structure from the program also. Just her illness... Who knows?

    So we stopped the Strattera she had a bit of a problem for a bit, went back on it got worse, stopped it again... got better. Difficult Child'd Strattera this time for good on the 5th. After only having been on it for 6 days, 40 mg.
    So she did horrible her first week of school, refusing, talking about wanting to die, kill us, trying to strangle husband, bite me, punch me, slap me...hit herself. Mostly over being told "NO", changing something(schedule), sister touching her, asking her to stop touching sister, asking her to do anything... brush teeth, get dressed. Very oppositional and defiant.
    So then last week we only had Abilify, Lamictal and Prazosin... upped the Lamictal to 150mg, Abilfy to 7.5mg and Prazosin stayed at 2mg... the Lamictal was 2 different 25mg increases over 2 weeks. Abilify was 2.5mg increase. She was great, Monday she had the opportunity to be the big sister and help N not be afraid and go to Pre-School, K explained to her that school was fun and not to be scared, I was so proud of her. Then my mother in law was visiting, from the week before, that hadn't helped her mood either!
    But mother in law's Mom had to be hospitalized on Monday and she had to fly out on the first flight, she was supposed to stay until Wednesday. K handled it so well and explained to N that we needed to be strong for Grandma, and that Mamaw was very sick and needed Grandma. (They don't think she is going to make it)
    I was feeling really good about the medications and everything, so I talked to psychiatrist3 and told him this, I said it is not perfect, she is very close to the edge of erupting, but she pulls it back in and she is taking time out's when needed, to re-gain her composure etc.

    Well it was like she was getting so close to the edge I guess and it was building up...Friday she lost it the worst I have seen in a long time... started in the am, didn't want to go to school, was obsessed with wanting to sew, screaming and yelling... got her school. Started back up when she got home. Went on... I asked her to wash her face... she lost it. We were going to go on a boat ride and I told her we couldn't go when she was acting like this. I said it was OK, but when her emotions were so up and down we couldn't go out on the boat. SHe needed to calm down and talk nice and get her "engine" back down because I thought it was running high.
    screaming ensued... she ran out of the house, (a first) husband had to chase her down and carry her back in, screaming and kicking, 56pounds!!!
    He had to restrain her, she was throwing things hitting, very violent... she is getting stronger!!!

    That went on for almost an hour....
    Today, husband is gone now, So today again, we had a good morning. Girls morning!!! We made breakfast listened to music (Happy Feet CD). They were being really good and N slept in her own bed for the 3rd night in a row!!! SO I said they could watch a short movie while cleaned up, but they needed to clean up their art table first... N started picking stuff up, I was helping, K lost it started slamming stuff, I asked her to stop. She didn't, slammed some more... said it was too much. I tried to explain that we were doing it together.
    I try really hard to make things easy for her, they have bins to throw everything in, I have gone over this a million times, if she wants to start a project she has to clean up the last one, one at a time... this table is in the front room by the kitchen, so they can work while I am cooking or paying bills or on the computer!!! I don't mind the mess so much but they can't do a project if there is stuff all over the table, and then she freaks over that!!! She has little shelves and cubbies to stash it all in...
    SO- I told her she needed to calm down NOW or she was going to take a T/O - she came at me and started punching me in the stomach and kicking me hard in the knees... I had to push her hard out of the way to get her to stop. She finally ran into the guest room...

    She finally calmed down and we talked about it, I told her her time in the room was her T/O, but now she had to clean up the mess by herself and explained why. She started to get mad, I said this is what got you in trouble... she did it I told her I was proud of her...
    she has been on edge all day...

    So I feel like she has some depression issues, ( she has been going on about how she is fat and ugly) :crying: which rips my heart out.... that along with the wanting to die... she is always saying she is bored, which is a sign of depression.

    I just don't even know where to go with this kid at times... or what medications to even thing of??? I am sticking with Lamictal I think just to see what it is gonna do...
    I want to keep the medications the same for awhile but I am just thinking about in the future... psychiatrist3 had mentioned that we will most likley have to address her anxiety and depression...

    I just don't even know how to treat her at times like this because, as her Mom I feel so bad for her, but I know she needs discipline and structure. I can't just give in to everything because she is constantly, changing her medications and unstable... I just feel like we never get a chance to move forward... even her therapist made a comment like that last week.
    She is so sweet and kind, I hate to see her hurt and struggle....
    I think we get to go in and see psychiatrist3 this week, Thursday, so I want to be prepared.
    I am SO sorry this is so long....
    thanks if you made it through any of this...
     
  2. totoro

    totoro Mom? What's a GFG?

    Thanks Nomad-
    We see the Therapist weekly, but just as she is touching on a subject... it is over. It never seems to sink in. We do have Clonidine PRN, it knocks her out and then keeps her calm... but these have hit SO fast... by the time I can give it to her she done with rage. She will not take it mid-rage! LOL

    I just feel at a loss sometimes, especially when husband is out of town, as to feeling creative!!! I am going to push therapist to work on the violence more... when it is over she is so remorseful and acts like she really understand and does not want to be like this... but once she is elevated again... all control is gone. I can see it in her face, she wants to hold it together... then she is walking around, "I am so stupid, I ruined everything, I have to move out"
     
  3. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm sorry she is struggling so much right now. So much of this sounds like my difficult child (just not recently). The medication merry go round is so difficult. Many gentle hugs-I know the violence is so scary and wearing.
     
  4. TerryJ2

    TerryJ2 Well-Known Member

    Wow. I'm exhausted just reading your note!
    Wish I could offer some advice.
    Here's a hug. {{{ }}}
     
  5. smallworld

    smallworld Moderator

    When my kids weren't stable on their current medication combo, we stuck to structure (school, therapy, bedtime, etc), but I relaxed my standards about certain things like cleaning up toys and hygiene. In the scheme of things, it just didn't matter to me and they couldn't handle it. If something like asking them to change their clothes was going to result in an hour-long rage, I wasn't willing to go there. Safety, above all, always came out on top.

    I agree with your decision not to take K out on the boat Friday, but I'm not sure you can reason with a child at a time of emotional intensity. In your shoes, I would have found an activity to distract her in an effort to quiet her down. Reasoning can only occur later when the child is calm.

    I personally think you're going to have to wait it out until the medications kick in to judge their efficacy. Each Lamictal change can take 6 to 8 weeks to reach effectiveness. Even though atypical antipsychotics work quickly, we've been told by our psychiatrist that full effectiveness occurs after a month. If certain things trigger K's rage, I sure would want to avoid them at this point.

    Hang in there. Hugs.
     
  6. pepperidge

    pepperidge New Member

    Hi totoro

    Wow, it is tough when they are totally unstable. I echo what Smallworld has to say about relaxing standards etc. Also reasoning. When I would try to reason with my son in similar circumstances it would only make things worse. But keeping structure in place is good. It is hard when they are volatile.

    I know you have had problems with Risperdal so you may not want to go there. but there is form that is melt in your mouth tabs which we used PRN, called them emergency pills! My son actually liked to take them.

    The only other thing I want to put out there for consideration is not to expect too much from therapy. My sons have both been in therapy forever (with different therapists) and frankly I would be hard pressed to say it has really made a difference. Kids just can't access their rational parts when their moods take over, I think, particularly one as young as your daughter. It might be worth really pushing your therapist about whether they have worked with similar children and what one can reasonably expect from therapy.

    Nonetheless, despite my misgivings I have continued with their therapy, figuring that maybe it is having some benefit I might not be aware of. Actually, I think what it can help with is getting the child to talk about their feelings about what they do when they are enraged and helping them not feel too guilty about what they do, without letting them off the taking responsibility for their actions. But all the stuff they have brainstormed with their therapists about what they can do--I haven't really seen them be able to access it.

    hang in there..



    Maybe others have had different experiences.
     
  7. smallworld

    smallworld Moderator

    FWIW, Zyprexa comes in a melt tab as well. It's been very helpful as a PRN when M has had rages or panic attacks.
     
  8. Big Bad Kitty

    Big Bad Kitty lolcat

    Aw hun

    I have read and re-read your post, and have been trying to think of something to say. Ya know. Something helpful.

    But considering that our girls are from the same dye lot, and I am not doing much better with mine, all I can do is offer a shoulder to lean on. It is SO exhausting. I know, I sympathize, holy moly I know what you mean. And what works one time does not work the next. It is a crap shoot every time.

    I am so sorry. (((hugs)))
     
  9. totoro

    totoro Mom? What's a GFG?

    Thanks Ladies!!!
    I agree about the relaxing the standards, I do. Her room is a mess right now and our upstairs play area is pretty messy, the family/TV area is "picked up" by all of us to help them deal with it... the only reason I even ask them to clean up the art area is that K has a bigger breakdown if it a mess and she wants to start a new project... you know??? I try to help her do one at a time and clean that, I always help her clean up when she is, unstable. Or asks...

    Even on Friday with the boat thing, I tried to keep it simple, "your engine is too high to go out and ride in the boat" before I can even get her distracted she is out of control... this is part of our problem. When she is more stable we can distract her at times like this, even if she is elevated. But right now her fuse just ignites at the drop of a hat...

    Tonight, she was OK about a shower, but no brushing of teeth. I have always been OK with stuff like that. I don't want to send her into a rage if I can avoid it with something simple like that!!!

    Sometimes the therapists is good for me and husband more than anything else....
     
  10. timer lady

    timer lady Queen of Hearts

    totoro,

    What helps difficult child self calm? If you see her engine running on high - what self calming activity can you redirect her to?

    For kt, it's a warm shower or maybe coloring. That doesn't mean the chore or whatever will not be done, I just give kt time to transition & calm the entire situation.

    The other reason I choose this route is that it isn't good or healthy for my difficult child or the entire family to be stuck in a rage/meltdown for that period of time. It's far too devastating for the entire household.

    When kt (or wm, when he was here) was this unstable, the only issue I was willing to go to meltdown over were medications & safety issues. The rest can & is worked out until kt (wm at group home) is stable on their medications.

    Keeping fingers crossed for a positive, meltdown free Monday ahead for you & yours.
     
  11. SRL

    SRL Active Member

    Poor little thing...and poor mom too!

    Totoro, I'm wondering if this isn't due as much to the start of school as to the medications. She had just undergone a huge transition from hospital to home and in only a few short weeks faced another one. Is she in a therapeutic school setting with classroom breaks, sensory issues addressed, etc? Sometimes a regular large classroom setting is simply too much for difficult children with this cluster of issues even if they do hold it together while at school.

    I can't remember all you've been through diagnostically but was an MRI, EEG, and sleep study part of that? medications and other interventions seem to have been basically ineffective so far and I'm guessing I might be widening the search for answers a little.
     
  12. Steely

    Steely Active Member

    Yea, I agree with SRL - I think the search for answers need to be widened at this point.

    She clearly does not respond to atypical antipsychotics, so I would be asking what this means? Does psychiatrist have the diagnosis wrong? Is there some other underlying condition that is not diagnosed? Is this why these select medications are not working? And since she is not responding to these medications, what other category of medications could be started to help?

    It seems Lamictal at 100 should have given you some relief - although not optimum - but you should have seen some differences. I can't rememeber, did that happen?

    I would also be asking if ALL testing has been explored for what could be going awry with her brain? neuropsychologist, EEG, MRI?

    Just thoughts, suggestions........I know you are absolutely drained from all of this. I can't imagine!
    Please know I am sending many prayers and hugs to you and little K.
     
  13. Steely

    Steely Active Member

    One other thought.

    I think it was smallworld's psychiatrist who said that he would not put a BiPolar (BP) patient with rages on Lamictal because with these types of patients the Lamictal can increase the rage. I am not sure of the source of that, but I think it was smallworld - it would be worth looking into.

    For my son, when he was on Abilify, it made him even more agitated and manic. We abruptly had to stop it, due to his somewhat paradoxical reaction.

    Do you keep a daily journal of her medications and her actions? If so, can you weave a thread linking certain behaviors to certain medications, and their increases or decreases?

    Just more of my rambling thoughts! :crazy2:
     
  14. smallworld

    smallworld Moderator

    While I have no problem with the suggestion to widen the search for answers and rule out medical causes, I think there are some important points to consider. First, it can take a very long time (months, even a couple of years) to stabilize a child with BiPolar (BP). T hasn't been at the medication game all that long with K, and her first few attempts at medications were low doses or not the right medication (and definitely not the right psychiatrist). Second, just because a child doesn't respond positively to APs doesn't mean she doesn't have BiPolar (BP). My own son, who very much has a BiPolar (BP)-like mood disorder, doesn't do well on APs so we don't use them. But he responds very positively to mood stabilizers. medication reactions in and of themselves do not a diagnosis make.

    About Lamictal: It was inaccurate info from http://www.crazymeds.org that I quoted about Lamictal. I don't think it's true. Having said that, Lamictal works best on depressive symptoms rather than mania. There's a posibility that K may need two mood stabilizers to get adequate relief. In addition, my son did not experience much difference at 100 mg Lamictal. Although he's a lot bigger than K, we really started seeing relief at 300 mg Lamictal (his current dose). K's increase to 150 mg was just made last week. It typically takes 6 to 8 weeks AT A THERAPEUTIC LEVEL to judge full efficacy. T has no idea what the new increase will do YET.

    T, hope you're having a better day today.
     
  15. SRL

    SRL Active Member

    I don't mean to question the BiPolar (BP) diagnosis. What made me think about broadening the search were the kids who have come through here who have had issues such as undiagnosed/unrecognized seizures or sleep disorders. Issues such as these seem to totally sink all attempts to stabilize through medications until addressed.

    I know K has been through a bunch of testing, so it's very possible these bases were covered along the way.
     
  16. totoro

    totoro Mom? What's a GFG?

    Thanks ladies you keep me on my toes!!! I do keep a journal of sorts, it is a shambles... I try to jot things down on the desk calender... and then later write them in my journal calender... but by the time I am writing, if at all my brain is fried!!! I need to update. I will go back over things I posted here, which is great for dates times etc!

    I think about all of the things mentioned... a lot. psychiatrist3 wants me to keep a journal as well. We did talk about EEG/MRI. Prior to dis-charge, I need to remember to bring it up again this week!!! He did not discount that something else could be going on.
    When he took us on he said he would take her as if she was BiPolar (BP), considering all of the history etc. but is open to his opinion as well and to watching how she does. Basically he was saying he wasn't going to challenge it... yet. The only other thing I could even begin to think it could be or in addittion to would be a type of seizure going on...

    The medications?!?!?! I was reading up on Lamictal last night... it was saying that it can help with the anxiety and derpression, I think that is why he likes it for her, or at least wants to like it for her!!!
    I just like going in there or talking on the phone with him with a back up plan... you know??? But right now I have no idea? Besides just keep waiting for the Lamictal to work better. She is far better that pre-medications... so who knows. That is why sometimes I would like her to just be on the Lamictal, to see what it is or isn't doing at this point...
    School... we are still waiting for the "Meeting" Teacher feels she is doing wonderfully... so how much do you push? WHat do I even push for??? No-one sees it... psychiatrist sees it therapist sees it... not the school yet.

    Thanks ladies, gotta go... School time!!! She is doing OK today, we did computer this a.m. and lots of pacing. short fuse...
     
  17. Gramma

    Gramma New Member

    I know the rages well. For the most part neither difficult child 2 nor any of us were safe from these rages. A rage started with something simple like being asked to brush her teeth, pick up her toys, get ready for school, do her homework, stop doing whatever it was she was doing that she wasn't supposed to be doing. I dreaded any interaction with her as on bad days, even a "look" would set her off. She was violent. She bit us, hit us, kicked us, threw whatever was handy at us, threatened to kill us in our sleep or herself.

    This child could scream a blood curdling scream non-stop for over three hours almost without taking a breath. Her rages lasted up to 6 hours and left us completely exhausted. We as a family, would lose any sense of normalcy during her rages. Our world centered around her: 1. to get her to shut up 2. to keep her from hurting herself.

    She would inflict serious injury to herself and not seem to notice the pain. From a standing position, she would fall stiff as a board onto the ceramic tile floor, hitting her head. She pounded her head into anything hard, bit and scratched herself until she bled, would choke herself until she had handmarks around her neck and she would turn blueish and pulled her hair out in clumps. There was no chance for redirecting until the rage was completely over. For the first maybe 4 years she wasn't on any medications and didn't see a counselor.

    Finally, out of desperation, we got her a counselor that thought she was scratching the surface, but the counselor took a job closer to her home and we were stuck with a new counselor that knew everything, but nothing. Had no clue what made kids tick as she didn't have any herself. difficult child 2 started sliding backwards, medications were introduced. They didn't help, husband took her off them and she did somewhat better. Lost our state medical, so lost our counseling, too. We are now without counseling for any of our difficult children.

    Although she doesn't rage anymore like she did, she still has the capability to do so. When she is upset, I see it in her eyes and then we double dance to fix whatever was wrong in her eyes so she doesn't rage again. This week-end, she tried choking herself again because she was blamed for something and again later when she was tattled on. I had hoped we were through that, but I guess not. We walk on egg shells and are constantly double guessing anything we say or do so as to not upset her.

    I believe in medications, just can't afford the private counseling and medication dr to get any. Then it is trial and error to find the right cocktail that will work on her.

    My heart goes out to you. I am sure you are beyond exhausted. I wish I could give you some hope to cling to, but I am still searching myself. Just know that someone out here really does understand what you are going through. Others outside of the home (teachers, etc.) may act as if you are making all this up, but I know you aren't. Hang in there. Maybe when she is a bit older, she may slow down her rages, too.
     
  18. Steely

    Steely Active Member


    I guess what I was thinking here.....but not exactly articulating, was - has K ever been tested for Pervasive Developmental Disorder (PDD) or Aspergers? I know from this board that some of these kids do not respond to anti-psychotics as successfully as kids without that component.
     
  19. sameold sameold

    sameold sameold New Member

    My thoughts are with you and your daughter, boy your post brought back some not so nice memories. Risperdal is the only medication my son has been on that helps with aggression. Weight gain is an issue and has been for years, but to keep him and us safe we have had to keep going back to it. Good luck
     
  20. Andrea Danielle

    Andrea Danielle New Member

    Hi Totoro, I am joining in late, but just wanted to tell you that I am reading your post with great interest. Our difficult child's are so similar, and are the same age. And, you sound just like me in your description of yourself. :smile:
    We are on this rocky road together!

    I don't have any advice since I am struggling in the same way but sending you a big hug! I hope things improve for you soon!

    Andrea
     
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