Med question and Tink update

[Big Bad Kitty]

SO, Tink now has a formal dx of bipolar and ADHD.

For a couple years, all prior to her first phosp visit, she was on Abilify. DUring those years we have trialled Metadate (made her cry), Focalin (made her violent), Tenex (made her sleepy), Prozac (turned her into her own evil twin). She was on Abilify only when she went to the phosp the first time. The doctor there gave her a med wash, then put her on Lithium and Seroquil. She got out and was readmitted the very next day. I told the doctors to take her off the Lithium because I did not like what it was doing to her. She was more belligerent than ever. So the doctor took her off that and put her on Adderall but kept her on the Seroquil. She was discharged a second time, and a couple days later I took her to see her regular pdoc. He and I did not like what the Adderall was doing to her eyes. Her pupils were huge! Plus she seemed agitated. So he switched her to Concerta.

She was beyond manic on the Concerta, not eating or sleeping, so when she went to the phosp for the 3rd time I ordered them to take her off of it. The doctor there suggested we try the Adderall again. She went back on it for 5 days before I asked them to take her off again. While she is not manic on it, she is very impulsive and unable to sit still. So after 2 days of no Adderall, we are tying Strattera.

Now I've read up on everything there is to read on all these meds, but I was wondering if I can get some first hand experience from the REAL experts - you guys.

As far as an update on Tink, she is still in the hospital, and I am hoping against all hope that she will be out by Christmas. We have a family therapy session today, and that will be key to her discharge - she needs to be able to sit through at least one session without flipping out. You know, there is a part of her that prefers to be in the hospital. It is safe for her. She misses me and all, but the second we start to talk about the real world and respecting me and my rules at home, she goes nuts. She actually tried to tell the therapist that if I have rules and consequences for her, then she gets to have rules and consequences for me.

It is the hardest thing in the world to give her the structure she needs at home. She fights me every step of the way. Plus she pushes my buttons and tries to make me feel bad for her when she is not getting what she wants. And the guilt usually gets to me.

Good news is I finally am getting help for myself. I have an appointment with the county next week with a therapist. The other bit of good news is that a lawyer is helping me pro bono to fight the school. All this time, Tink has never had an IEP. After her discharge last time, they gave me a consolation prize of a 504, which was stupid. It stated that Tink was only to attend half days and no homework. At first it actually sounded like a pretty good idea, to ease her back into school, but the kid is gonna fail 3rd grade if this keeps up. So the lawyer contacted the school district, and within one day they agreed to put her in a therapeutic school while they conduct a case study.

Sad that it took a letter from an attorney to get that. I've only been asking for 3 years.

Sorry this got so wordy. Look forward to comments!

[smallworld]

Hi, BBK. I'm sorry things have been so rough for Tink and for you.

If the pdocs at the hospital truly think Tink has bipolar disorder, they should forget about the ADHD meds, including Strattera. That means only first-line mood stabilizers (Lithium, Depakote, Lamictal, Trileptal, Tegretol) plus atypical antipsychotics (Risperdal, Seroquel, Abilify, Geodon, Zyprexa). If she did well on Abilify, I see no reason not to go back to that (or if Seroquel is working, stick with that) and trial a different mood stabilizer from Lithium since Tink didn't seem to do well with that one.

For what it's worth, Strattera is an antidepressant that is used for ADHD. It is only effective in 40 percent of ADHD cases, and side effects include anger and irritability. You may also know that kids with BP tend not to do well with antidepressants, especially when they don't have a mood stabilizer on board (which Tink doesn't). BTW, Strattera typically takes 3 weeks or so to kick in so you shouldn't see immediate results.

The reason the pdocs aren't able to stabilize Tink is that they're concentrating on the ADHD part of the equation instead of the mood piece. When medicating kids with BP, you need to focus on mood stabilization first and then deal with residual symptoms afterwards. Sometimes what looks like ADHD clears up when mood stability is achieved.

You might want to take a look at the Treatment Guidelines on the Child and Adolescent Bipolar Foundation website at this link:

http://www.bpkids.org/site/DocServer....pdf?docID=441

This very helpful document, written by a consensus conference of child and adolescent psychiatrists, is based on medical literature and includes step-by-step strategies for treating mania and depression in young patients. Some parents find it helpful to print it out and bring it to appointments with their children's pdocs.

Hang in there, BBK, and let us know how today's family therapy session goes.

[crazymama30]

I agree with smallworld, but I know for my gfg and dh they both need a stim thrown into their mix but, and this is a big huge but, it had to be added only after they were stable on mood stabilizers and an ap. Gfg did horrible on stims alone, and I do hope to get him off it eventually.

I would try to go the route of no stim, it is certainly safer. AD are another big no.

Have they tried Lamictal yet? If not, it may be a good option. I wonder if they have not tried it due to the fact it takes a while to titrate up on it.

[JJJ]

I 100% agree with smallworld. The moods must be stabilized before the ADHD can be addressed (plus the ADHD may really be mania and if the moods are stabilized, she may not need more meds than that).

What dose of Seroquel are they giving her?

For Tigger, Clonodine helped with the ADHD symptoms that were left after his moods were stable.

[crazymama30]

I agree with smallworld, but I know for my gfg and dh they both need a stim thrown into their mix but, and this is a big huge but, it had to be added only after they were stable on mood stabilizers and an ap. Gfg did horrible on stims alone, and I do hope to get him off it eventually.

I would try to go the route of no stim, it is certainly safer. AD are another big no.

Have they tried Lamictal yet? If not, it may be a good option. I wonder if they have not tried it due to the fact it takes a while to titrate up on it.

[gcvmom]

Smallworld is right on target with her adivce. And I can verify it from our own personal experience. Gfg2's ADHD symptoms and hypomania improved significantly once we got him off all stimulants and on a mood stabilizer and AP combo (for him, it's Depakote ER and Seroquel XR). The residual problem with focus and attention are being addressed with a third medication (Namenda) that works on glutamate (a neurotransmitter that works on these aspects) and it really has helped.

I hope you can get things sorted out for Tink soon. The two of you have been through a lot lately.

(((Hugs)))

[TerryJ2]

I agree wholeheartedly w/the others.

Plus, I think you have a clone of my son: if I have rules and consequences for her, then she gets to have rules and consequences for me.