which mood stablizer ?

Discussion in 'General Parenting' started by jannie, Mar 16, 2008.

  1. jannie

    jannie trying to survive....

    I know no one here is a doctor..but I've heard people say that certain mood stablizers are used to treat certain symptons.

    I really believe gfg2 needs some type of mood stabilizer. For the past 1 1/2 p-doc has told be to start him on trileptal. I haven't... I've trialed other things....However, he is moody...each month he has some bouts of bad days being extra angry or down...then he seems fine Throughout the rest of the days he goes from normal to extra happy (lots of singing) and all over the place...who knows...he's just not right.

    I think the Lexapro really helps...but sometimes I think it's too much and possibly causing him to be a bit manic....but then I seem him being a bit depressed..and then he's been so impuslve and socially immature this year...and then he's been more confident and comfortable and able to do things he hasn't done in the past. He's going to new places, being less anxious...so it does help...but....

    And then the vyvanse...I really think it helps him to sustain himself in school...and be less hyper.

    The doctor keep saying you know he needs to just try the trileptal so now what, that's three medications....and most people so nothing wrong with him at all. He's an above grade level straight A/B student who falls apart at home--what with that??????

    I know these mood stablizers take so long to work...I know one benefit of trileptal has to do with no blood draws, but the counter to that is you never know if the level is really therapeutic. How does one decide to trial lamictil versus trileptal...so something else....maybe we should just start with deptakote or lithium...who knows.....

    Do you think that Lamictil and trileptal or just "light" mood stablizers...for kids that have a more mild type of mood disorder...versus a more full blown??
  2. MidwestMom

    MidwestMom Well-Known Member

    Ok, understanding that I am not a doctor (and don't play one here) lol I 'll just give you a totally non-medical opinion, as a mom who has done the med thing with myself and my son.
    Pretend your kid was my kid, and this is only what *I* would do, not anyone else here: I would want him off the ADHD med. I don't believe you can or should try to medicate away every symptom. I'm for getting the most out of a med for less. As for the Lexipro, yes, that can cause swinging moods, if the child has a mood disorder. I would also want to slowly wean off of that (and he will get worse before better because there is a bad SSRI withdrawl syndrom). I'd want to start over and try a mood stabilizer first. And if he tends toward depression, my personal choice would be Lamictal. Then I'd take it from there, but I wouldn't like the doctor to say, "Oh, so he's got anxiety? Another pill. Oh, he's inattentive? Another pill."
    I have bipolar and at one time I was on so many meds I barely knew my name anymore. I was completely zombied out. I'm sure people thought, "Wow, it's working. She's so calm" lol. That wasn't it. I felt awful and foggy and wanted to die, but I was easier to be around because I could barely react. So rather than piling med upon med, I would start with a mood stabilizer. For inattention I'd get school supports. Stimulants can and often do work against a mood stabilizer, as can STraterra, an antidepressant. You will NEVER get rid of every symptom, but you CAN cause your child to be emotionally dead. There is a difference between good medication that helps and too much medication that shuts down a person's ability to feel.
    Anyhow, JMO
  3. Sara PA

    Sara PA New Member

    What do you mean by "light" mood stabilizers?

    Lamictal is recommended for people who deal mostly with depressive phases; Depakote and Trileptal/Tegretol for people who tend to be manic.

    Lamictal doesn't require blood draws either.
  4. smallworld

    smallworld Moderator

    Again, we're not doctors, but here are some general thoughts on mood stabilizers:

    Lithium is the gold standard for treatment of BP. An estimated 70 to 80 percent of bipolar patients have a positive response to it. But it is thought that "rapid cyclers" may not to do as well on Lithium as other mood stabilizers.

    Depakote works very well for mania and mixed states. My own kids became irritable and depressed on Depakote, but their illness tends more to depression than mania.

    Tegretol is an effective treatment for acute mania and works to prevent future episodes of bipolar illness. I actually don't know all that many kids on Tegretol.

    Trileptal is an anologue of Tegretol, meaning it is structurally similar but differs slightly in its compositon. Its effectiveness is still being evaluated for children. My son's pdoc said he did not believe it would be strong enough for an adolescent boy.

    Lamictal works best on the depressive end of BP. It is FDA-approved for the longterm maintenance of BP. My own kids have done very well on it with zero side effects.

    FWIW, my 13-year-old daughter has been stable on a combo of Lamictal and Lexapro for more than a year. In fact, we are reducing her Lexapro in the hopes of keeping her on Lamictal monotherapy.
  5. klmno

    klmno New Member

    I second MM (I'm not a dr either though) and just want to add that apparently the effect of a particular mood stabilizer can be very different from person to person. My gfg is on lithobid and depakote er right now. pdoc says he'd like to try adding something else b/c he thinks maybe starting gfg on mood stabilizers has "brought out" an adhd side. I am saying "no" to this b/c I believe that he was either adhd or he wasn't but if he is hyper and inattentive now, then the mood stabilizers aren't quite where they should be yet- and besides, it is my understanding that adhd isn't intermittent like my son's "symptons" are. So, also, be prepared to spend some time going through different meds and dosages before you get to the right "fit"- from what I hear, sometimes you get lucky with the first one tried, but other times, it takes a "trial and error" period. Of course, any decrease or change in meds should be done under close supervision of pdoc.
  6. jannie

    jannie trying to survive....

    I'm not really sure what I mean by light...I avoided the medication thing for a while with my son.

    My younger son was the handful and we focused so much energry on him...however we always knew things were going on with gfg2. I saw symptoms of adhd in preschool (impulsive, active,) but he never had the meltdown and rages...he could handle "no"(GFG1 was the one who was flying off the handle).. GFG2 is very smart and excelled in school so his focus in k and 1 was about raising his hand, working slower, handwriting, and writing concerns.

    No medication until spring of grade 3
    Trial tenex april-July

    July Straterra two weeks bad...

    Last year August 06-April 07 he was on abilify-He was pretty dull and made anxiety worse, somewhat depressed not good

    April 07-July 07 No Meidcation -hyper, anxious, talkative, hyper, angry, moody, impulsvie, all over, -just not right he needed something

    Vyvanse is the first and only stimulant he's ever been on. He was moody before and moody after. I don't think it's made it worse.

    Basically I think the Lexapro Vyvanse combo has been ok...I just think he has some type of mood disorder.

    I think I'll stop the Vyvanse for a few days since there is know with drawl.

    The thing is...I'm can't say if I think he's more depressed or more manic. I think he's both !!!! Lately he's been more manic....but he used to be more depressed.
  7. smallworld

    smallworld Moderator

    Lexapro could be causing disinhibition or mania.
  8. Sara PA

    Sara PA New Member

    Antidepressants can cause mood cycling, not just mania as is often mentioned. Stims can cause cycling within a 24 hour period because of the rebound effect.
  9. klmno

    klmno New Member

    Not to sabatoge the thread- I think this is still OT-

    Before I forget, maybe by light dosage you mean he just needs to cross the therapuetic threshold of meds, but not be at the upper end of it. That would be determined by blood draws and pdoc and how well gfg is doing on that dosage.

    Anyway- that was useful info Smallworld, I think I'll note that for future reference. I had thought my gfg would do better on lamictol b/c he has more depressive periods (or used to) than manic periods. But when we tried it gfg was in a hypomanic or manic state and lamictol caused him to stay awake, hyper of course, for about 32+ hours straight. The question is- does the effectiveness of the med or reaction to the med differ depending on what state the cycling person is in when that med is started? In other words, would gfg had a better reaction to lamictol if it had been started while he was in a stable or depressive state?
  10. Kjs

    Kjs Guest

    My son did fantastic with Lamictal. There was a dramatic noticable difference. That was his only med. We tried adding Lexapro for anxiety issues, that was a disaster.

    He stayed on Lamictal for almost 3 years. When he was doing well for a long period, we began to wean him off.

    He is currently taking concerta on school days. I do not see a difference, but he insists it helps.

    He has some rough days, but not angry like he once was.
  11. Sara PA

    Sara PA New Member

    I would think so. Mood stabilizers don't treat acute phases, they treat the chronic condition. They reduce the amount of cycling over the long run. However, they can have an effect on the acute phase, as can so many other things. Lamictal is know to interfer with sleep for about three hours after being taken so it shouldn't be given to someone, especially before bedtime, who isn't sleeping. Conversely, one of the mood stabliziers which has the immediate effect of making someone sleepy -- Tegretol -- probably shouldn't be taken by someone, especially in the morning, who is already lethargic.
  12. klmno

    klmno New Member

    Thanks, Sara!!
  13. pepperidge

    pepperidge New Member

    For what its worth, my depressed anxious son was helped alot by Adderall (less oppositional) but Prozac made him disinhibited and really didn't seem to deal with his irritability. We trialed Trileptal. It was a disaster. but works for some. I have to say, I have been really pleased with Lamictal. Minimal side effects, first time in a long time that he has gone to school without complaining. He still takes Adderall (a very low dose) which works great for him.

    It is just my impression, but I think Lamictal if one has a kid towards the depressed, irritable end of the spectrum seems to have given better results than Trileptal, at least from what I can gather reading stories here.

    Starting Lamictal, I would just go really low and slow. My younger son developed some kind of rash, we stopped Lamictal but then reintroduced it later on to no problem. None of the mood stabilizers have worked for him, but he has other issues (mostly impulisivity and perseveration and disregulation).

    Good luck.
  14. crazymama30

    crazymama30 New Member

    I think that different people react differently to meds. If there is a close relative who has been on a mood stablizer then I would take their reaction into account. We had a similiar reaction with Lamictal, gfg developed hives, we stopped all meds untill the rash was completely gone, restarted Lamictal and no more rash. FWIW, gfg did horribly on depakote and lithium. He also did not tolerate stims well alone, but seems to do well on Daytana 10mg as long as he is stable on his Lamictal.

    DH is on Lamictal also (he was diagnosed after gfg). DH was on geodon and developed tardive dyskensia, and now is on Trileptal and Lamictal. DH's pdoc asked for a list of meds that gfg has tried and how he reacted.
  15. jannie

    jannie trying to survive....

    So I spoke with his teacher today...and I really do think he is showing many symptoms of being manic....very impusive...socially immature and alll over the place...and a bit ocd as well....so I guess I will.....UGH I DON"T KNOW WHAT I WILL DO !!

    The p-doc has given three options.

    1. Increase the lexapro--see what happens (my gut thinks this will make it worse)

    2. Decrease the lexapro--see what happens
    or

    3. Increase the vyvanse....stop the Vyvanse

    or

    4 Keep Lexapro and Vyvanse as is and start to trileptal

    I think he thinks we should start the trileptal and keep all as is.
  16. susiestar

    susiestar Roll With It

    Jannie,

    Go with your instincts. Be aware that some people with bipolar get stuck in "mixed states" where they are between manic and depressed, but have the worst parts of both.

    But no matter what, go with your instincts. You are with this child more than anyone else (other than immed family) AND you know all his history. PLUS nature gave you instincts to ensure the survival of your child, and thus the species.

    Personally, if you think there is a mood disorder, I would want a medwash (get rid of vyvanse and lexapro) and THEN to try mood stabilizer med. From the research I see, it is very hard to tell if a mood stabilizer is just another pill or is working unless it is given w/o antidepressants or stimulants.

    While you have probably read The Bipolar Child, it is always an interesting re-read, at least the parts dealing with certain problems, like meds. There IS a protocol for treating mood disorders that is approved by the Board who certifies pdocs. If anything, you might want to find it (it was on here a while ago) and ask the doc if you could follow THAT for a bit.

    Hugs,

    Susie
  17. looking4hope

    looking4hope New Member

    I'm no doctor either, but here's my two cents:

    There is no "miracle drug" that works for everyone. It's a hit and miss process. My GFG was on Lamactil, which didn't work. We tried Abilify, and not only did it not work, but he had some side effects that made it not an option. We tried Depakote alone, then with Zyprexa. Finally, we switched out the Zyprexa for Seroquel, and replaced Concerta with Strattera, and he's been fairly stable for almost six months. He still has some anger management issues, but they are maybe once a week or every ten days, versus several times a day.

    You need to find a pdoc who will work with you. When we were going through this process for finding meds, he was seeing GFG every week to assess the effectiveness of the meds, realizing that it would take several weeks for the meds to take full effect. Basically he was looking for subtle differences in behavior to determine if this is the path to go or not. It worked for us.

    I hope this helps, and that your GFG can finally find the right meds for him.
  18. smallworld

    smallworld Moderator

    To confuse the matter further, there is a side effect to antidepressants called disinhibition, which is NOT mania and NOT related to mood disorder. It simply means that the dose is too high and is causing the child to lose his natural inhibitions. No matter what you decide, I would not increase the Lexapro.

    If you're interested in trialing Trileptal, I agree with Susie -- I'd recommend trying it without any other meds involved. It's the only way you're going to know if it's working or not. Trileptal cannot overcome the bad effects of either ADHD stimulants or antidepressants if you are indeed seeing med-induced mania or cycling.