A Confirmed Diagnosis and a Tentative Diagnosis

[welcometowitsend]

So we have finally had the dr.'s appts. we have been waiting for. The paediatrician was on Saturday and not only did I appreciate him seeing my child on a Saturday but he spent quite a lot of time with us and never seemed rushed to leave - only focused on the situation at hand.

difficult child was very belligerent and oppositional towards the pediatrician. throughout most of the appointment.. He was so rude it was embarrassing but I know it gave the doctor a glimpse of what he can be like. It was nowhere near what he's like at home but it was a glimpse. Paediatrician confirmed Tourette's and ADHD are accurate and he added clinical depression and then he mentioned ODD. I know how many feel about an ODD diagnosis so I took that one in stride. The other three I already figured on anyway.

Today we saw the psychiatrist. 9:30 - 12:30. She comes highly recommended and I can see why. She took a good detailed history of our family. Asked many questions and gave husband and I an Autism Spectrum Disorders (ASD) screening questionnaire (DSM). She spoke with all three of us for about 1.5-2 hours then with difficult child alone for about 30-40 minutes.

The DSM questionnaire came up VERY UNLIKELY for Autism Spectrum Disorders (ASD) so that was a good thing.

Her diagnosis is clinical depression - moderate. She is also looking at the possibility of emerging bipolar. The bipolar wasn't an instant diagnosis because the only bipolar diagnosis in our family is a cousin of mine. Lots of addiction and depression and anxiety in my family but only the one bipolar diagnosis that I know of. So many of my mother's siblings don't speak to each other so I have no idea what the situation is with any other cousins - I wouldn't even know where to find them.

She was looking at bipolar because of his sleep issues. He can sometimes go days without sleeping more than a couple of hours a night and maintain high energy and function. Also he can be very irrational and angry for no reason. The anger could be part of the depression or ADHD so she wants to hold off and see what SSRI's do for him.

We are looking at the following for medication. Ciprolex to start. Possibly introducing lithium, adhd medication and risperdal. She wants to treat the depression first to see if it will alleviate the anger. And if he is bipolar we will likely see the manic phase show up within a month (geez I hope not) and can then introduce lithium as a mood stabilizer. (What are your opinions on this???)

We didn't get a prescription today because difficult child was diagnosed with Vaso-vagal syndrome 2 years ago. Basically he has a low heart rate and low blood pressure which can cause fainting/blacking out upon standing or sitting up from a prone position. His ECG's, Echocardiogram and Holter monitor test all came back clear but the psychiatrist wants the paediatrician to verify that the medications won't cause any problems for difficult child.

So after the appointment I went into the pediatrician.'s office and gave the note to the secretary. She will consult with the pediatrician. and get back to me. We will either have a follow up with the paediatrician or he will just write a prescription for the SSRI and we can start there.

So difficult child is a little disappointed that he didn't get immediate help in the form of a prescription. I think we are all starting to feel a little desperate at this point. But we are all hopeful that we are making progress in the right direction. It's a bit of a relief and sadness - relief that we have a diagnosis and sadness that this could be a permanent challenge in his life.

I also have a call into our family doctor because my husband is very worried about me. I'm having trouble sleeping, trouble eating, have the shakes and have been having panic attacks lately. So, I guess I need to get some help too.

 

[welcometowitsend]

I just looked online and it looks like SSRI's might actually help decrease symptoms of Vaso-Vagal syncope. Couldn't find anything on lithium but risperdal doesn't look good. He already has Tourette's and there is a warning for people with low blood pressure.

 

[InsaneCdn]

Ugh.
The BiPolar (BP) diagnosis is a concern - because the medications you would use ADHD, depression, etc. are things that tend to make BiPolar (BP) worse, from what I've been told.

Which ADHD medication? (makes a big diff)
Risperidal... huge side effects, including light-headedness, so not sure how that plays into your difficult child's other dxes, but can be beneficial in getting a handle on executive function, more often used if there are Autism Spectrum Disorders (ASD) traits.
SSRIs either work ... or are a disaster. And with BiPolar (BP), I think it's more often disaster.

The whole anger/depression link, though, is well known. Depression in the male gender often presents as anger. If it IS depression, then you'll need to get to the next level of "why", because frequently (not always) the depression is secondary - there are other things going on and not being dealt with, and THAT leads to the hopelessness and dispair, and both need to be treated.

 

[Calamity Jane]

WWE,
I'm glad you have excellent doctors and that difficult child even showed up without too much fuss. Yes, depression/possible emerging bipolar diagnosis is not what you would want to hear, but you knew deep down it had to be something like that. I hope the bipolar doesn't turn out to be what he has, but I'm sure the medications will help, and he can see positive improvement.

You sure have been through the grinder, so seeking help yourself is a smart move. It's never easy. I wish you peace and good health. You're doing great so far.

 

[Wiped Out]

(((hugs))) I remember that feeling of relief when difficult child was diagnosis'd with bipolar. Relief that others saw what we saw and relief that we could begin treating it along with that feeling of sadness you experienced. However, I was also hopeful because we could begin to move forward.

I do know that my difficult child never did well on anything for ADHD until the Bipolar was under control (which for us took years-but that is just us). We just recently added in Strattera but it isn't helping much with the ADHD symptoms. He is doing much better with his bipolar in the past few years (for my difficult child).

 

[welcometowitsend]

Calamity - Thank you. I have been suspecting bipolar for a while now but I have a tendency to be one of those people who thinks that can't happen to me or my family. It's ridiculous thinking, especially when I factor in the mental health issues on my mothers side of the family. This, however, has been something we can't ignore or deny.

I'm hoping to hear from the paediatrician by the end of this week but I guess that will depend on getting the echocardiogram (somehow he never got a copy of it 2 years ago) faxed to his office as well as the notes from the psychiatrist consultation sent to his office.

We are all relieved he does not have Asperger's in addition to the depression/bipolar, Tourette's and ADHD.

Insane - I think the Risperdal may be out because it can lower blood pressure, as does clonidine which was another medication that was mentioned.

The trial and error process will be interesting. I sure hope it is short and we find what works quickly.

WipedOut - Wow, I am so sorry it took such a long time to get your difficult child's BiPolar (BP) under control. I wonder if that had anything to do with him being so young? I am wondering how the hormones and growth will affect how well medications will work or continue to work with difficult child? This is all very new to us so it will be a big learning curve.

It is my understanding that our dr.'s will take the same approach as yours. Get the depression/BiPolar (BP) under control first and then address ADHD or other issues. I think it is a good approach to take because the aggression and anger could very well stem from the depression/BiPolar (BP) and if so he may not need ADHD medications - unless they introduce them for attention instead of behaviour. Based on the brief amount of research I've done on ADHD medications I'd rather stay away from them for difficult child, if possible. (easy child is on Concerta right now - just trying to get the dose right for her - inattention not behaviour for her) His Tourette's is so mild right now that I wouldn't want that to go full blown because of the stimulants. Not sure if the side effect would be worth the benefit.

 

[TerryJ2]

Very interesting appointment. And interesting that the Autism Spectrum Disorders (ASD) came out as being unlikely.
I haven't heard of that first medication at all.
I would normally agree that stimulants can make bipolar worse, except that my son is now on lithium and both that and the Adderall seem to be helping.
He wasn't on Zoloft long enough to find out if it worked; way to many, severe, side effects.
Definitely factor in the low blood pressure issue; that's why psychiatrists are MDs ... they're dealing with-medications.

 

[lovelyboy]

I also find your post very interisting.......
My son was initially diagnosed with ODD...then the psychiatrist diagnosed Autism Spectrum Disorders (ASD)....My son definatly doesnt have ADHD....maybe a bit of ADD.....but he has emotional regulation issues. We started of with Risperdal, but it increased his irritibility very much! Then we tried Tofranil....he vomited.....Then we started Cipralex....Sorry to say, but we never had a wow moment that I could honestly say he got much better....His meltdowns have improved, but it could be because of the Occupational Therapist (OT)......He does cry less....and his obsession with blood and gore has improved. For myself...Cipralex made me VERY VERY nausious! And it made me VERY anxious...My son doesnt complain of side effects, BUT he sometimes gets headaches, dont know if this is because of the medications? He is still VERY and I mean VERY irritable....shouting at some one if they touch him or make a noice....
The psichologist I took him to this week also suspects BiPolar (BP), deffinatly impulse control problems and also say mood disorder....Didnt mention Autism Spectrum Disorders (ASD)!
So we are seing a new Neuro in Sept....to sort out the abnormal EEG in the R posterior temporal lobe( this regulates emotions!)....
Then we also maybe need to do the medications change! I know. The psychiatrist wanted to put Abilify in the mix to help with the mood regulations...
I am happy you got help....My only concern is that they are introducing 2 new medications at once...So if your son shows side effects, how will they know wichmeds is causing it? I would maybe ask the doctor to maybe start with Risperdal?

 

[welcometowitsend]

I called the paediatrician yesterday. Should have answers on the prescriptions by Monday. difficult child is gone to a friends cottage for the weekend and I wouldn't start him on anything and then send him away for a few days anyway.

Terry - I think the ciprolex, which is an antidepressant will work differently than Adderall which is for ADHD and is a stimulant. Lithium is a mood stabilizer. If difficult child does get a confirmed diagnosis of bipolar he will be on lithium to prevent manic episodes.

Lovelyboy - I hate that these medications can have so many adverse side affects. I'm hoping that difficult child responds to the ciprolex (or whatever medication they decide to use) and doesn't have adverse side effects. My sister said it can be a very effective medication but then a friend of mine was on it with horrible side effects. Trial and error, I guess.

Sorry about the confusion - they are only introducing one medication at a time. For the exact reason you stated, they want to be able to determine what is causing side effects so we are going with the antidepressant first and then if he proves to be bipolar they will likely introduce lithium as a mood stabilizer (or maybe Abilify). Then, once that is stable they will look at treating the ADHD if necessary.

I think that once we get the mood disorder under control the rest of it should stabilize itself. That along with some cognitive therapy should work well. At least that is what I am hoping for.