Akasthia vs mania

[klmno]

With a couple of references to akasthia on other threads, I'm left with wondering how you can tell the difference? Is it just trying to reason it out (ie, there was a recent medication change so it probably is akasthia) or is there a way to tell for sure?

I have so many doubts about difficult child's medications. I'm going to respond on my previous thread about where to go from here, but these doubts about medications are haunting me.

difficult child appeared to exhibit BiPolar (BP) signs a year ago last summer, after being suddenly taken off prozac for what psychiatrist believed was prozac induced mania (he had just had the prozac doubled). I couldn't get difficult child in for a long, non-acute, psychiatric hospital evaluation, so we kept difficult child off all medications as long as possible for psychiatrist to try to determine if the symptoms would go away or if difficult child was BiPolar (BP). I was pressured from the GAL to get this kid on medications, I couldn't afford $900 to get psychiatrist into court to explain all this, I was scared about what I was seeing and hearing in difficult child- difficult child told me there were times that his body didn't feel normal and that he didn't feel pain normaly for long periods of time and that this had been happening for over a year but he didn't know exactly how long. He answered psychiatrists questions about all this and I told psychiatrist I didn't want to wait any longer- put difficult child back on medications.

So psychiatrist started difficult child on MS's. After a couple of trials with lamictol, then regular lithium, difficult child started titrating up on lithobid. Then, difficult child had a few weeks where he couldn't sit still, was jittery, talking excessively, what we thought was hypomania. So, psychiatrist added depkote er. (difficult child was getting frequent blood draws so maybe psychiatrist determined it wasn't akasthia from those results?? Is that possible?)

After a few months, difficult child exhibits stuff like that again, along with inability to sleep. So, we try adding an AP, PRN. Things get worse, difficult child ends up in psychiatric hospital for a week (this past spring).

Anyway, I lay awake and cringe many times that maybe the problem is too much or the wrong type of medications. Or, maybe these medications aren't doing anything at all- maybe he really is BiPolar (BP) and we see the signs of cycling but the medications don't help- when we think they are helping and have the cycling under control is really when the kid would be going through a period of stability anyway.

I'm not suggesting that difficult child stop taking medications and I'm certainly not going to quit giving them without psychiatrists instruction. I'm just wondering if anyone else has doubts like this??

And from what I've described about difficult child's medication history and symptoms, can you tell if that was akasthia or hypomania??

 

[smallworld]

Akathisia typically occurs as a side effect to APs, not MSs. You said he got worse when he was given an AP. Which AP? How often were you giving it? By "worse," what do you mean?

 

[klmno]

Well, I can't remember what we tried first- zyprexa I think and we didn't know if he should have more or discontinue use, as difficult child was just starting on it and was titrating up. We didn't know if it just wasn't at a therapuetic level or if it was a bad medication for him. Then, psychiatric hospital took him off and strarted him on seroquel. psychiatrist dropped seroquel- he said with difficult child's legal and school issues, he was concerned about putting difficult child through that period of getting him from the low tranquilizing dose to the higher mania-control dose. Something about it would knock him out for a week and it wouldn't be a good idea for difficult child's situation and because difficult child is so sensitive to medications, there were too many risks of how difficult child might respond. So, psychiatrist then changed to risperdal prn. Then we just stopped trying with the AP's. difficult child is normaly stable thru summer and he really didn't need an add-on this summer.

psychiatrist said he thought it might be more anxiety driven a couple of mos ago- we tried the anti-anxiety medication; difficult child said it made him more "jerky" as in having physical jerks and jittery and keyed up. Then, difficult child was showing major signs of depression (lack of motivation, excessive sleep, crying very easily, sad, hopeless, etc) so psychiatrist added the AD and raised the depakote er. Then, we found that difficult child was physically ill as well, and medications for that were added.

I just stopped the AD yesterday and I'm putting him back to the original dose of depakote today.

Answer to questions: We thought it was going into mania, I don't remember the exact symptoms, but some were the type where it's hard to tell if it's mania or depression- aggression, change in sleep habits,- oh, he was acting erratic which is why we started it then the erratic behavior and aggression got worse. (He was walking around on the roof at one point.)

It does make me feel better to know that akasthia probably would not result from a MS. Thanks!

 

[Jena]

Hi

I have these same thoughts quite often, once you get mixed up in the medication game at times it is difficult to remember where you started off and if the medications' are actually helping or making it worse.

I wish he would of just left him on the seroquel to see if that would combat the anxiety and see if it would help with the depression. I'm so there with you, it's hard with our kids because alot of times certain medications trigger the exact symptoms we're are looking to get under control. Than it becomes a guessing game ok is this really him, or is this him reacting to the medication? when's your appointment with the doctor again

 

[gcvmom]

If he's not currently on an AP, then perhaps what you're seeing is really hypomania. And if he's been on medications for his physicall illness (don't remember what you said it was), maybe THOSE are interfering?

Also, I could be wrong here, but I don't think akathesia involves pressured speech like you see with hypomania, or distorted thinking. It's mostly the motor activity issue.

How's he doing today?

 

[Jena]

i know everyone screams mood stabilizers, and for alot i'm sure it works great which is great!! yet with me I think ok if i can tackle the other prevelant and outstanding issues whether it be non sleep, anxiety, etc. than i can see what i'm left with from that point, instead of handling it from the other side. does that make any sense?? LOL

 

[BusynMember]

Akathesia, which I had once, is a horrible, terrible feeling. I got it from Zoloft, but you can get if from antipsychotics too. I spent three weeks in a very big university psychiatric ward in Chicago and the most patients who had akethesia were actually on anti-psychotics. Of course back then they used Haldal and Thorazine, but they caused akethesia often. It is a feeling of needing to jump out of your skin, high HIGH level anxiety, the bright lights seemed too bright, and I could NOT sit. I had to be put on one Valium every hour until the Zoloft was out of my system or I could not stop pacing or shaking. It was terrible timing as my boys were graduating that night and I had to try to sit through the ceremonies. I barely made it. I ended up in the hospital.

 

[klmno]

Thanks gcvmom- that info makes me feel better too!

One of his physical medications given was albuterol- I have no doubt that it interfered. I told difficult child on Thurs that unless he feels a rattle in his chest, not to use it. difficult child had no difficult child symptoms before he was 11- or right before he turned 11yo. He did have ashmatic wheezing off and on (seasonal) from the time he was a newborn to 4 1/2 yo. He was given albuterol. After the more intensive albuterol treatments, difficult child would act differently- what I would now call "manic" or as a baby, he would lay there and scream a scream like I never heard from him otherwise.

 

[klmno]

When difficult child was taken off the prozac and on no medications, he told psychiatrist that he could not sit still, he could not quit talking, or quit biting his nails, that he didn't feel normal, that he couldn't help it. We knew he was telling the truth because WE could SEE it. And, this was totally out of character for difficult child.

Can prozac cause akasthia?

 

[Jena]

i think it can based off my experience with difficult child, i went thru that when she was on prozac, and we had to pull it.

 

[TerryJ2]

Just sending support, Klmno. So sorry. Poor kid. Poor you. Wish I could help.

Great description, MWM. So sorry you had that reaction.

 

[smallworld]

My understanding is that Prozac can cause disinhibition and it can cause hypomania/mania. I don't recall our psychiatrists saying it could cause akathisia. Akathisia is a side effect to APs that consists of external and internal restlessness that looks like anxiety and agitation but in reality is not. When my son experienced akathisia while taking Risperdal, he had a hard time sitting in the car (we were driving from Connecticut to Maryland three Thanksgivings ago), and he growled at and pushed away anyone who came near him. I think MWM's description of wanting to jump out of your skin is a good one. He was not talking excessively (that sounds more like mania to me), but was incredibly edgy and jumpy.

Here is a link to articles written by Dr. Ellen Leibenluft, a researcher of childhood BiPolar (BP) at NIMH. Click on the last article for a good description of the hallmark symptoms of mania:

http://intramural.nimh.nih.gov/research/pi/pi_leibenluft_e.html

Hope that helps.

 

[klmno]

Thank you!! This has been a big help- it sounds like I can rule akasthia out and quit worrying about it.

So, has anyone come up with a blood test this week that can just tell us for sure if the kid has bipolar, and if so, exactly what medication combo is best for him? (I know- dreaming again...LOL!))

 

[Jena]

I wish they had one as well. When you find out pm me with where to go!! it's all so confusing at times, isn't it?? just round and round we go.

Midwest mom sorry to hear what you went thru. it was such a good description to help klmno out though.

they do speak of cat scans' mri's have you ever heard that talk at all???

 

[klmno]

Yes, thank you MWM- that was very helpful- sorry I didn't mention that before...

I have heard of the mri's and other brain scans but from this board and what psychiatrist says, there is not yet any definitive way to test for this.

 

[BusynMember]

If Zoloft can cause akethesia, and it did for me (I was in ER and they could barely get a pulse because it was beating so quickly and I had every physical symptom of akethesia) then so can Prozac or any antidepressant. Zoloft and Prozac are cousins. No doctors ever told me about akethesia. When I got it, I freaked out. Akethesia WAS my diagnosis. It was different than mania although it looked like it, but I was NOT in any way happy or irritable. I was freaked out by the icky feeling of wanting to just jump out of my own skin. I can't describe it any other way. It probably looked like I was hypo-manic because I could not stop pacing and I snapped a lot and cried about how I just couldn't stay still, but it was different. It's not anything I want to go through again and I know first hand that antidepressants can cause it. I'm guessing that almost any medication can. Depends on your body chemistry. BUT...there is also a withdrawal syndrome for SSRIs...so it could have been that too. As soon as they pulled me of the Zoloft, and they did NOT wean me, I started calming down. I had only been on it for a little while and what a nasty ride it was for me. And it wasn't fun to be hospitalized over it. It kicked off a depressive episode and screwed up my body chemistry to be pulled off of it, and took me several weeks to get stable while they tried another medication.

 

[klmno]

Thanks again, MWM! Do you think it would have been there 6-8 weeks after suddenly stopping an ssri (no titrating down)? Of course, I still have to consider the actions/symptoms that were there before- I'm just trying to look at everything objectively.

 

[BusynMember]

If it's been that long, then no. I would think it is more an SSRI withdrawal syndrome maybe. Here's a link to what that is:

http://bipolar.about.com/cs/antidep/a/0207_ssridisc1.htm

 

[smallworld]

I stand corrected. Prozac and Paxil have been linked to akathisia. Here's a link to an article about akathisia and what medications induce it:

http://en.wikipedia.org/wiki/Akathisia

Akathisia frequently calms when the medication inducing it leaves the body. Mania frequently does not calm when the medication inducing it leaves the body. In fact, mania can go on and on until a MS or AP puts a stop to it.

 

[klmno]

Well what do you all think- last year- should he have been on a MS to start with?