Gfg's "brain feels funny" (long)

[tictoc]

Hi,
Gfg has been wild, absolutely wild, and defiant since Thanksgiving, after four months of positive steps. He's had a growth spurt and we decided on Thursday (along with the psychologist and pediatrician) to increase his imipramine, which in the past has helped a lot with his OCD, leading to a generally calmer gfg (we have not increased it yet). He is already at a high dose of clonidine and everyone involved is reluctant to raise it again. Also, his wildness goes way beyond ADHD. The psychologist and pediatrician think we should try Risperdal, but Dh is adamantly against it. As for me, I say bring it on. We need help.

***Just to clarify, we have not made the med increase yet***

Anyway, since the middle of the week his energy level has been ramping up. Yesterday we spent the afternoon at a friend's house and he and his friend had a very wild, but good and peaceful time. However, upon getting home, he continued to ramp up and told me that his "brain feels funny." I asked him what he meant and he said that it started at his friend's house. He was so wild all evening that I took PC to her room to read just to keep her out of harm's way. He wasn't aggressive, but just flying around and unaware of how much "space" he was taking up.

I went to bed at 9, when DH took gfg upstairs to put him to bed. I woke up around 1:00 to them coming downstairs. Turns out that gfg had not been able to sleep at all. He was still very wild, with flushed cheeks and a bright gleam in his eyes. He was happy and not aggressive, but could not control himself. He wanted to jump off furnture, make loud noises with our digital piano, and was talking in a very loud voice. DH was going to let him watch a video (out of pure exhaustion, I think), but I suggested we play a board game instead--seems more calming. So, DH dozed, while gfg and I played games until about 3:00. He commented at one point, "My brain feels better now." And, he did get calmer, but was still spinning around on the hard wood floor between his turns and being a little "off."

At about 3:00, PC woke up and was very confused by all the ruckus. I took her back to bed and Dh took gfg upstairs, again. I don't know what time gfg finally fell asleep. I know that he and Dh made at least one more trip downstairs (woke me) sometime in the night for a drink. It is now almost 11 a.m. here and they are still asleep. It looks like Dh finally gave up and slept in the guest room upstairs and that gfg climbed into bed with him at some point.

We were supposed to go out of town for the weekend, but I think that is off. I can't imagine putting gfg into the car for a 3 hour drive after last night. PC is going to be upset, but I think it will be for the best. We were going to increase the imipramine on Monday, but we can do that today if we stay home. We have an appointment with a new psychiatrist at the end of January (we are on the cancellation list, too) and in the meantime will continue to see the psychologist and pediatrician. But, we need more help.

The psychologist has at times mentioned that we need to be on the look out for signs of early onset bipolar disorder. There is a history of BPD in my family, as well as schizophrenia, and lots of alcohol and addiction issues. Dh's family has some history of mental illness and addiction. Both of us have our depression and anxiety issues, but no addiction issues, and we do well, given the genetics in our families. It seems like all of this has come to roost in gfg.

The psych says his big concern is that gfg is so hyper and irritable, simultaneously. For the past 3 years, I would say that this has been his predominant state. As his tics have worsened, I would also say that he seems depressed at times. I've never felt like I see rapid cycling, though I'm not really sure I know what that looks like. However, he does seem to get stuck in "states." This period of high energy and defiance since Thanksgiving is one of those states.

We have had a thorough neurpsych eval and he did not rise to the diagnostic level for an autism spectrum disorder. However, his social skills are bad and he often does not "get" it. He receives social skills therapy through the autism inclusion program at school and has a one-on-one aide.

Thanks for your input.

[smallworld]

So the wildness and staying up all night occurred before you increased Imipramine? Have you had good luck in calming this kind of behavior down in the past with Imipramine?

How much Prozac is he taking? How long has he been on it?

[tictoc]

Smallworld, Yes, the wildness and funny feeling occurred before increasing imipramine. In fact, we haven't increased it yet.

He stared Prozac in June (.3 cc of liquid Prozac--that is about 3 mg, I think) and imipramine in August (6.25 mg). We previousy tried Zoloft (12.5 mg) and he had only two doses before being wild for a week. We never gave the Zoloft to him again after those two doses. Our psych has wanted him to have an SSRI or tricyclic to help with his OCD. The combination of Prozac and imipramine at very low doses, along with a whopping dose of clonidine, has worked quite well since August. We have definitely had issues along the way, but they have been fairly minor and fleeting. Overall, the past 4 months have been the best we've had in several years, until now.

Thanks.

[smallworld]

In your shoes, I don't think I would increase Imipramine before letting the pdoc know that your son stayed up practically all night. What you're describing sounds like antidepressant-induced hypomania/mania, and I'm concerned that if you add more antidepressant, you may make him worse instead of better. Kind of adding fuel to the fire, so to speak.

I'm not a doctor, obviously, just a parent who has three children who have had lots of bad reactions to SSRIs. I'm having a hard time understanding why your pdoc would put your son on two ADs, but I think the combo is revving him up instead of calming him down. In your shoes, I'd ask to wean him off the Prozac, which can cause a lot of disinhibition. My own son had a rage reaction to one day of 5 mg Prozac and broke a window in our house. My younger daughter got giddy and disinhibited on Prozac and then had a 45-minute rage in the car. We discontinued it after that.

By way of history, my son also had a manic reaction to three weeks of 25 Zoloft that did not settle down for weeks. We needed to start him on mood stabilizers after that.

I do want to warn you that reaction to meds is not diagnostic in and of itself. But we now know beyond a doubt that my son will never take SSRIs again. He just can't handle them at all.

Please be careful with what meds you give your son at this point. You don't want him to get worse instead of better. Hang in there.

[Hope]

I just looked up imipramine because I had never heard of it and my daughter has OCD so I was interested in it. On Wikipedia, it said that imipramine is known to cause mania or hypomania in 25% of the people who stay on it. I k now Wikipedia isn't the best place to go for information on side effects, but do think this is worth mentioning in your situation.

Prozac kept me daughter awake the one time we gave it to her, so I would be suspicious of either of these causing this.

[smallworld]

Anafranil is the gold standard for OCD. Imipramine is in the same med class. Both are tricyclics.

[MidwestMom]

I took Imiprimine and got psychotic on it after six months. It seemed to be making me better before that...but it did amp me up. A doctor can draw an imimprimine level (mine was toxic), however some people get toxic on normal levels. Very confusing. Prozac can take a while to get to a level in your bloodstream that also causes mania and violence (not that it always will, it helps some people, but Prozac has been a very poor drug in our family). It made my son manic (and he's not bipolar). It made my daughter pull a knife on herself. And it made me feel really strange after about two months...I fell asleep at work and had horrible nightmares and felt extremely wired. Then it pooped out entirely.
I can't tell you what to do, but I know what *I'd* do with all my experience in drug taking (I felt like a science experiment) I would ask the doctor to wean down the meds to see if that helped way before adding another one.

I'm sure you are aware that with Tourette's there is an extremely high % of bipolar. OCD too. Is your psychiatrist very aware of Tourette's and the other problems it can cause?

I hope things settle down. IMO it does sound drug related. And too many doctors want to add drugs or up the drugs before possibly thinking that maybe decreasing them first would be a better solution.

Good luck, whatever you decide to do!

[gcvmom]

Some people cannot tolerate tricyclics, and just because he's been on it for a while doesn't mean he can't eventually develop a bad reaction to it. My Gfg1 became very disinhibited on amitriptyline, another tricyclic. It also made him very irritable and aggressive, but this came on so subtlely that we thought it was just puberty-related issues because of the timing. But as behaviors got worse (not all the time, but mostly when his stimulants wore off), his pdoc suggested lowering the dose. And when I saw that the behaviors improved with this move, we decided to just eliminate that altogether.

The brain "funniness" and other behavior really does sound like hypomania. We've experienced that here with my Gfg2 who has a bipolar dx.

Like others have said, I'd be inclined to back off on one of the meds first before increasing anything.

Good luck!

[ML]

Manster has gotten like this before but for him the chlonidine tames it. He also as tics (maybe tourettes), ocd and GAD. These are the things on his official dx but we now understand that for him, AS covers it as an umbrella. Have you looked at that possibility? Not that that matters actually, it's about treatment, not that label. I sure hope the medication adjustments make all the difference. Thinking about you, ML

[tictoc]

Hi everyone,
Thanks for your replies. I am calling the psych and pediatrician in the morning to describe the situation and get their input before we do anything else. Your input has really helped me with this decision. It is what my gut was telling me, but my Dh is so reluctant to admit there is an issue...But, there clearly is! Seven year old kids do not typically stay up all night.

Gfg got up around noon yesterday. He has been defiant, irritable, and surly since then. He talked so much and so loudly Friday night that he is still hoarse. Dh and I are exhausted from being up Friday night and from dealing with the discipline issues. I keep reminding myself, "He didn't choose to be this way." That does help.

MWM: To answer your question, yes, I think our psychologist is very experienced with TS and all of its comorbid conditions. We have yet to find a good psychiatrist, however, but hope the person we are seeing next month will be better than the last. For now, we are combining a psychologist and our pediatrician in treating gfg. All involved agree that this is not the best option, but it is the best we can do until we get into the next psychiatrist. We live in a medium-size city that unfortunately does not have a lot of psychiatrists, but we are within a few hours of two major metro areas. So, we can head out of town to find a psychiatrist if necessary.

Thanks again to all who replied. I'll keep you updated. And, here's hoping for some sleep.