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??