What medications can be used prn for bipolar disorder?

Discussion in 'General Parenting' started by givnmegryhr, Jan 31, 2007.

  1. givnmegryhr

    givnmegryhr New Member

    difficult child is on Risperdal and I have the feeling it is losing its effectiveness. He is very impulsive. He is also on Lamictal and Trileptal. psychiatrist had us try Trazodone, but it didn't do anything but maybe hype him up abit. She wants to try Strattera which scares me or Topomax, but is open to suggestions. So I would like to know what prns your kids are on . He needs something to calm him when he gets really angry. Last nite he left a wonderful bite mark on my wrist. Thanks.
     
  2. Sara PA

    Sara PA New Member

    PRN? Generally speaking, the major tranquilizers, also know as the antipsychotics, are used PNR. Both Zyprexa and Risperdal come in a quick disolving form generally used in emergency situations. I have never heard of an antidepressant (Trazodone or Strattera) or an anticonvulsant (Topomax) used PNR.

    FWIW, I have noticed from anecdotal reporting that when Lamictal and Trileptal are used together, parents report some activation of mania.
     
  3. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Ive taken both trazadone and topamax and neither are a prn medication.

    For me, the best prn was klonopin but Im an adult.
     
  4. smallworld

    smallworld Moderator

    We use Zyprexa PRN for all three kids. As Sara said, it comes in a quick-dissolving tablet that is easy to use.

    What dose Risperdal is he on, by the way? Maybe it needs increasing . . .
     
  5. timer lady

    timer lady Queen of Hearts

    kt has always had access to seroquel prn. It's proven to be fairly successful for her.

    wm, on the other hand, has risperdal.

    Good luck - not many psychiatrists give prn medications for fear that parents will over use it. I had to fight like the dickens - then prove that it was used only in situations that needed a chemical restraint to break the cycle of aggression or self harming.
     
  6. givnmegryhr

    givnmegryhr New Member

    He takes 1.25 mg Risperdal split up throughout the day. I called the psychiatrist and asked about Zyprexa. She told me it is just like Risperdal. She said we could go up on it again. Up to 1.75. Sara, the Topomax wouldn't be used prn . She just mentioned trying it. I will ask her about the induction of mania with the Lamictal and Trileptal. I didn't realize Trazodone and Strattera were antidepressants. Thanks for the info. I think the easiest road right now would be to increase the Risperdal first to see if it helps. It was the first medication to help his hostility. Thanks everyone.
     
  7. crazymama30

    crazymama30 Active Member

    I have seen some people (adults, never children) who use Trazadone PRN for sleep.
     
  8. Martie

    Martie Moderator

    If you try topomax, make sure the dosage is increased VERY slowly.

    Martie
     
  9. pepperidge

    pepperidge New Member

    HI
    we use Risperdal PRN, though now that my son is on .75 mg day of Risperdal (along with Lamictal and Topamax) we don't need it PRN. We have seen good results with a combination of Lamictal (which seems to help the depression) and Topamax (which seems to cut down on the hypersilliness). He had a real bad reaction to Trileptal, which is what we tried first.

    Topamax is not good for some, but my son is on 100 mg and it does not seem to have had any negative side effects. We started at 25 mg and worked our way up real slow.

    good luck.
     
  10. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I don't know (nor does anyone) what would help your son, but I'd say a big NO to Straterra. I have no idea why he'd even suggest it--it's an antidepressant and for ADHD and is known to make bipolar kids even worse. Often Tenex and Clonodine are used.
     
  11. givnmegryhr

    givnmegryhr New Member

    The psychiatrist told me Trazodone is used for adults for sleep. She said she had good results using it prn for children to calm them. We already tried tenex and clonidine with opposite reactions(bounced off the walls -no sleep those nites!). MidwestMom, I actually got out The Bipolar Child book and read to her what it said about Straterra. I agree with you. I have heard of some who have had good results, but its not one that I feel comfortable trying right now, if ever. I will keep Topomax in mind. I myself have just been started on Lamictal . Its been 2 weeks so I haven't noticed any changes yet. I spoke to my psychiatrist about trying Topomax for the appetite suppressant side effects alone. She hasn't ruled it out ,but we'll see how the Lamictal works first.
     
  12. Sara PA

    Sara PA New Member

    This could be why the Tenex (and, likely, the Clonidine) didn't help:
    [ QUOTE ]
    Guanfacine and Juvenile Bipolar Illness

    Authors: J.P. Horrigan, M.D. and L.J. Barnhill, M.D.

    Guanfacine hydrochloride (Tenex) is an alpha-2 adrenergic agonist which has received recent attention in the field of child and adolescent psychiatry due to its apparent benefits in managing attention-deficit/ hyperactivity disorder (ADHD), tic disorders, and posttraumatic stress disorder. The initial reports noted minimal side effects. This poster details six cases of adverse responses to guanfacine, drawn from an initial clinic sample of 95 outpatient boys and girls aged 8 to 15 years who were seen in a university-based developmental neuropsychiatric clinic. In each case, the patient met formal DSM-IV criteria for ADHD while four out of six also met criteria for Tourette's Disorder. Within 72 hours of initiation of guanfacine therapy, drastic changes in mood and behavior occurred in each of these individuals, culminating in states that resembled hypomania and mania, including elevated mood, poor sleep hygiene, and hypersexuality. The dose of guanfacine ranged from l to 2 mg/day. Later investigation revealed that all of the youngsters had clinical and/or familial risk factors for bipolar disorder. The authors speculate about the possible mechanisms behind these side effects, and suggest that bipolar disorder may be a relative contraindication to guanfacine therapy.

    [/ QUOTE ]

    Does the doctor propose adding yet another anticonvulsant (Topamax) or replacing either the Lamictal or the Trileptal with it? Keep in mind that all anticonvulsant have a certain degree of cognitive dulling and that Topamax is the worst.
     
  13. pepperidge

    pepperidge New Member

    My son had the reaction described to Tenex--he got very irritable, aggressive, had trouble sleeping, etc. He would get violent. It was scary. Didn't happen right away--took a couple of weeks to build up.
     
  14. givnmegryhr

    givnmegryhr New Member

    That is very interesting Sara. I will take that info to the psychiatrist. I am assuming she is planning on replacing one of the moodstabilizers with the Topomax. I am firmiliar with Topomax being a big cognitive duller. I will be sure to address this with her. Thanks for your help!
     
  15. AK0603

    AK0603 New Member

    [ QUOTE ]
    difficult child is on Risperdal and I have the feeling it is losing its effectiveness. He is very impulsive. He is also on Lamictal and Trileptal. psychiatrist had us try Trazodone, but it didn't do anything but maybe hype him up abit. She wants to try Strattera which scares me or Topomax, but is open to suggestions. So I would like to know what prns your kids are on . He needs something to calm him when he gets really angry. Last nite he left a wonderful bite mark on my wrist. Thanks.

    [/ QUOTE ]

    My son has just started this drug this week. How long have your difficult child been on it? Also I'm curious to know if you can use it on and off, like an as needed basis?
     
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