Discussion in 'General Parenting' started by klmno, May 6, 2008.
Is there a time release version?
Yes, but it's relatively new and it has gotten mixed reviews among the parents of the BiPolar (BP) kids listerv I co-moderate. Our own psychiatrist said he's never had a problem with the regular version so why switch to the ER version. FWIW, my own son takes 700 mg Seroquel all at night (it was titrated up by 100 mg every few days).
Wow! difficult child started on 12.5 (1/2 pill) per day and then after three days went to 25 mg/day (evening) with my option to add 1/2 pill in mornings. He appears to be sleeping well on it but said he is tired during the day. I also, noticed that late afternoon/early evening tonight he had excessive talking, verge of raging, but was eventually reeled back in before it got out of hand. (This had been the time of day that he had been manic before going into psychiatric hospital.) It was difficult child himself who asked if seroquel came in a time release form. If most kids are taking several hundred mg per day, I can't imagine that this is doing anything for difficult child. But then, the 5 mg of zyprexa was zonking him out without clearing up ANY mania at other times of day and psychiatrist said many start on 20 mg/day. I don't know what to think- I sure wish I could have gotten him into day treatment. I haven't compeltely given up- I just don't see any opportunity yet.
difficult child has had a long history with Seroquel. It does last quite some time in thier system. However, during difficult child's more difficult times, she has required a small 3pm dose (25-50mg). She's been on up to 400mg, but it was starting to make her too groggy. She has always needed a morning and night dose-with the night being larger ususally. Right now she just started a larger dose during the day. I know that in addition to the regualr doses, smaller PRN doses can be given every 4 hours for extreme anxiety and mania. But doing that really becomes more sedating than the mood stabilizing.
From what I've read, Seroquel is dosed for sleep issues in the range of 25 to 200 mg and for mania in the range of 300 to 600 mg. Some kids require in the range of 800 mg because of how they metabolize the medication. Sedation effects tend to decrease over time and in higher ranges (I know that sounds counterintuitive).
You're right that the dose your difficult child is taking might not be doing much at this point. You may just need to give it time as your difficult child adjusts to the medication.
Serquel has never been a wow medication for my son. He has not had ill effects but we have not noticed much of a difference in behaviors when the dosage is increased. It does make him very tired so we give it at night. I am wondering by what others said, if we should give a small portion of his dosage in the afternoon as this tends to be a rough time for him. I was also surprised by the dosages. My son has been on it for two years along with other medications and is only at 175 mg. Maybe the resaon we don't see much result from it is that the dosage is too low?
Christy (and others), Seroquel has been an amazing medication for my son. He had suffered from depression for more than two years, and after trials of many medications, it was finally the one to lift his depression.
When my son was in day treatment last December and Seroquel was added to his medication mix, his attending psychiatrist told us that the therapeutic dose of Seroquel used to be 200 mg. But patients were reporting that it was pooping out after a while. It was discovered that the body metabolizes Seroquel faster and faster over time so in effect the dose was decreasing. It is now believed that the dose has to be higher than 200 mg to be effective for mood instability and mania.
Thank you! This information makes me feel a bit more comfortable.
ok- psychiatrist at psychiatric hospital had started difficult child on 1/2 pill for 3 days and discharged me saying to give him a whole one at night and 1/2 in mornings. (This was because I called him Mon am with concerns that difficult child seemed hypomanic when I saw him over the weekend) psychiatrist said difficult child's thyroid levels were fluctuating and maybe that had something to do with the signs I noticed. Anyway, I was a little concerned about making that much of an increase in dosage at once due to difficult child being more sensitive to medications than most. So, I have just given him a whole one each night and none of it in the am. I've changed my mind tonight. Something absolutely has to be done about what he is like between 4:00pm and about 6:00-6:30pm. I'm not comfortable giving an afternoon dosage without seeing the regular psychiatrist first- which will be in 2 weeks- because there is a po and gal monitoring treatment. Do you think giving the 1/2 in the am will "last" him through the early evenings? Tonight, if he hadn't just gotten out of psychiatric hospital, I would be on my way to get him in.
Also, how on earth can you split these tiny pills in two evenly? I tried- I didn't do too well. (I was trying to prepare for tomorrow.)
It's difficult to predict whether the morning dose will last through the afternoon because the dose is so small.
Do you have a pill splitter? I bought mine at the pharmacy, and it cuts in half any size pills.
I didn't know they mad pill-splitters. I'll pick one up. If regular psychiatrist would return my call, I'd ask about additional dosage, but..... I guess I'm going to have to look for another psychiatrist, it appears I've worn our welcome out with this one.
He's stirred up again- angry- in the yard hitting a tree with a hammer- very angry.
Just my 2 cents..............12mg of Seroquel? That is like eating one Smartie! (You know, the candy?)
I understand psychiatrist wanting to be cautious, but that is a bit too cautious. My son at your difficult children age was on 400 at one point when his mania was out of control. I know all kids are different, but perspective is crucial.
I agree with Steely. My son is a medication reactor, and his psychiatrist started him at 100 mg Seroquel and went up by 100 mg every few days until he hit a therapeutic dose.
Thanks, Ladies! Right now, I am at witz end. The psychiatrist won't call back, difficult child wouldn't go to school today- he said he didn't feel good. PO called to cancel this afternoon's appointment. because she said we had court tomorrow am and that would count. This was supposed to be only for difficult child to sign some Paper (I can't find out what) due to him being in psychiatric hospital last week when his last arraignment was scheduled. PO also said she was meeting with her supervisor this afternoon to discuss difficult child and whether or not he should be put back on monitor. Then, I come home at lunch since difficult child was still home in bed. Two summons (one for each of us) to appear in court tomorrow are on the door. I have 3 phone calls in to find out if these are a formality from last week's postponement or if PO or GAL are doing something more. The odd thing, the arraigning judge has always been some different person- but this summons is ordering us to court in front of the judge that always hears difficult child's case. I had sent a 3-page faxed update to GAL last weekend. It explained difficult child's signs of cycling, his report to school of drug/alcohol dealers, his going to psychiatric hospital without having to be tdo'd, the distress that the monitor at school caused him, etc. She returned my call and seemed pleased that she had gotten this. Now, I'm wondering if she was pleased because it somehow gave her enough ammunition to nail him/me or if she somehow woke up to his mental health problems. It is clear that the PO will never get to that point.
difficult child isn't helping here. I've yelled cried everything to try to get him to see that he needs to do whatever it takes to help himself and keep going even when he doesn't feel well or even when his moods seem out of control. His answer is to detroy the house and become passive-aggressive towards me. (I should have foreseen that.)
We had an article in our newspaper last Sunday on mental health and lack of treatment for juveniles in our area. It said 70% of juveniles in detention had mental health issues that were inadequately treated and that parents were being forced to turn their kids over to the state to try to get treatment- which of course, we know that still doesn't get them adequate treatment. Right now, I don't know how I'm going to keep myself from being locked up! I just keep thinking- there has to be a better answer.
My son needs help- it is clear. I would gladly quit fighting the courts and asked for help if they would do anything helpful. That is exactly how we got stuck with this gal last year. And, I had actually asked for difficult child to be put on probation too, because I had been lead to believe that the PO could get adequzte help for difficult child. Neither the gal, or the PO has gotten anything useful. And him being put in detention won't either.
Just a vent- sorry-
So sorry. Sending many hugs.
I can only imagine that your difficult children stress is over the top, like yours, with all of this court stuff. High stress levels trigger mania. It is a lose - lose situation.
Keep paging psychiatrist and demanding an increase on the Seroquel - I really think it might be your ticket. There were days my son was pretty out of it, until we could find the right level - but at least he was not destroying his self and his life in a fit of mania. Personally, I would rather see him temporarily sedated, than out breaking the law and altering his life permanently.
Thanks, Steely. It was pretty bad today. It breaks my heart to say but he wrapped a cord around my neck and started to act like he would strangle me. I stopped him. He pushed me down on the floor and kicked me on the shin. I have "F my Mom" (exactly like that) engraved in the wall by a kitchen knife. He stsill agreed to go to his individual counselor. (The one I think/thought was a quack.) So, I go in there with difficult child and start out by asking if he has ANY experience with a kid who has mood cycling. He says yes. So I proceed with- well my son is manic and violent tonight and he has been coming here for 11 mos, everyone is telling me that medications won't take care of it all, this is what my son has done tonight, need I remind you of the court situation and legal situation and his psychiatric hospital stay lsat week, so I think it is time some real issues are dealt with.
difficult child starts saying that he isn't really bipolar, he wants to grow up and be a drug dealer, he doesn't need medications, he's angry with everyone in the world, etc. (I am sure everyone reading this has not read all my previous threads, but these contradict every action that my son has made in the past year.) Then, he says he will tell the judge tomorrow in court that he isn't really bipolar and doesn't need any kind of help- that he has been faking all of this for TWO YEARS. I tried to explain that I didn't blame difficult child for having this problem, but medications alone won't solve it and he HAS to start helping himself. Furthermore, I am more than a little ticked that I am the ONLY ONE paying for defense attny fees, restitution, medication insurance, etc., and he attacks ME??
therapist asked me to leave room, and I did. After about 20 mins they come out. I say I need to ask therapist one quick question so difficult child leaves the area. I asked therapist if my difficult child has been acting this way every time he has come in or if he saw a change like I did. therapist said difficult child is cycling, no he hasn't always acted this way and that difficult child told him he hasn't been taking all his medications because he wants to be able to stay up at night and play his video games. I said difficult child's blood levels have just been checked twice this past week and they are where they should be. He said difficult child told him he knows which medications he needs to take to keep his blood levels at a good place. Then, he said he told difficult child that he strongly suggested that he take his medications tonight and if the judge asks tomorrow, he should tell judge that yes, he does have a problem. He said he told difficult child that he believes he really does have a problem.
I hope this guy is telling me the truth and not covering for difficult child if difficult child has been acting this way for the past 11 mos to him. He damn well better not be faking. And, then I wonder, if psychiatrist is not returning calls because he has been in contact with po or gal and recommended a lock up. psychiatrist doesn't even know about all this- he won't return recent calls. The last call he returned, he was frustrated with me for calling so much.
Why do I feel like I should be posting on the PE forum? (Just because he seems to be having issues more like those over 18 yo.)
I might have to delete this post tomorrow. Why can't I just get more treatment thatn a psychiatrist every 3 weeks (at best) without losing custody? What are they going to do- give custody to my bro. - like that will solve the problem. My bro doesn;t have a clue about this kind of stuff.
He does sound manic (grandiose thinking, wanting to stay up all night), and the only treatment for mania is medications. Mania can't be treated with counseling; only depression can. I sure wish you could get more Seroquel in him. It sounds as if he really needs it.
I'll be keeping a good thought for you tomorrow. Hugs.
I'm thinking about calling psychiatrist from psychiatric hospital and see if he'll ok a higher dosage. The problem of course, is that if I gave him more than what was prescribed the PO and GAL and judge would hang me.
And- how in the world do you toss all medications (2 lithobid and one zyprexa or seroquel- or- 2 lithobid, 2 depakote and 1/2 seroquel) in your mouth at once and not swallow the teeny tiny pill, but swallow enough to keep blood levels appropriate?
I sat there in therapist's office saying "but you are the, difficult child, that told psychiatrist that you thought you were BiPolar (BP) because your body didn't always feel normal, etc; you are the one that just reported 3 people at school last week for drug/alcohol issues; you sat there in psychiatric hospital and said you had to tell them something so you told them you were angry even though you didn't feel that way."
I'm just venting- I'm sorry- I wish this system that is trying to just take control of it all could actually help. I honestly do see it as a lose-lose situation. If I couldn't remember my son in his stable times (which really do happen, and last for months, and he's a good kid then) - I would have him out of here tonight or tomorrow. That is why I wanted to know from therapist if difficult child is really like this all the time and he's just hiding it from me. Do you think therapist would lie to me about this?
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