I think the difference between mood disorder not otherwise specified and bipolar not otherwise specified depends on the edition of the DSM you are looking at. Older ones called it one thing, newer another. He may be using those words to try to help you understand what is going on, not saying it is this or that. Of course I could be totally wrong.
I thought abilify and zyprexa were the same kind of medicine. If he is thinking of mood disorders, those NEED the be the first condition treated. OFTEN if a patient is treated properly for bipolar the symptoms that look like adhd and many other things go away. But if they treat the adhd first, the adhd medications will actually CAUSE the mood disorder to spin out of control and there will be no way to stabilize the moods.
Go and get a copy of The Bipolar Child by Papalous TODAY. It is excellent and will help you make sure she is getting what she needs. THe medication protocol is in the book and is what the Academy of Child and Adolescent psychiatrists approves, but for some reason that makes NO SENSE to me and that NO psychiatrist has EVER been able to explain, the psychiatrists want to use antidepressants and stimulants first and NOT work to stabilize the moods first. I have asked a LOT of docs about this because every time we had to change doctors for Wiz they wanted to give him a different diagnosis. Not so much because the diagnosis he had wasn't right, but more because they wanted to do something different (I call it reinventing the wheel and it drives me absolutely crazy in this situation!). Every one wanted to say Wiz is bipolar, which he just isn't and never has been, but they don't want to treat the bipolar, they wanted to give him medications that would make bipolar worse. Often they made notes saying I was a difficult parent to work with because I just don't bend on this issue. Goody for them - a few showed me where they wrote it in Wiz' chart, somehow thinking that it would make me let them do what they wanted and mess up my kid jsut to do it. Now I think it was funny, at the time I thought they were idiots (well, I still think that about a few of them,lol).
Anyway, with a mood disorder suspected, medications are now a HUGE issue. YOU have to be super educated on this. You MUST know the medication protocol and you MUST know the names of the medications and what type of medication they are. You have to be willing to ask for time to look up a medication and get back to them. They will NOT like it, but it is better to wait a few hours or a day to start a medication than to end up spending precious days or weeks trying to undo the chaos the wrong medication can cause.
A LOT of medications can cause moods to cycle for someone with bipolar/mood disorder not otherwise specified. The medication protocol calls for first using a mood stabilizer and an atypical antipsychotic to stabilize moods. TWO mood stabilizers can be used together if needed to achieve this goal (along with the atypical antipsychotic). Once moods are stabilized, if symptoms of adhd, depression, or other things still persist, LOW doses of stimulants, antidepressants, antianxiety medications etc... can be added in carefully.
One of the big problems is that mood stabilizers don't work quickly. They take time, weeks usually, to get to therapeutic levels. They have to be at therapeutic levels for 6 weeks to get the full effects. So you have to work up to the therapeutic level and then wait 4-6 weeks to know how well a medication will work. It is incredibly frustrating but when you find the right medication combo it is very very helpful.
I know this medication combo is the right way to handle medications because a lot of parents have told us about what a HUGE change it makes when you finally find the right combo and wait it out until it works. MANY of these parents previously had said how great an antidepressant helped but their child had huge mood swings and often ended up in a major crisis because what the antidepressant did was make them cycle and esp trigger the manic states. We also have parents here who are bipolar and went through this all. One in particular spoke with me about how she knew of the protocol with the stabilizers but for her an ssri antidepressant made her feel SOOOO much better and was just waht she needed and that protocol wasn't for everyone with bipolar. Not long after that she had a crisis and she returned to us a year or so later and posted about the experience. The antidepressant she thought was helping was actually hurting her, but in a manic state you don't know it. You also don't have to be in the stereotypical manic state or stay manic for days/weeks at a time. Some people, and esp kids, can cycle much much MUCH faster than that (I know a little girl who cycles about every ten to fifteen minutes when unmedicated, more on mds for adhd!! It is exhausting for everyone around her and she has NO control over herself.)
PLEASE get the book I suggested. Educate yourself about bipolar. If you push for mood stabilizers and atyp antipsychotics, it won't be a quick fix, but it can be a way to get help that lasts, and that will then let her use the tools she can learn in therapy.
