Bipolar medications update

[branbran]

The doctor just called. They will be taking my daughter off the Concerta, if they can get her to agree to take a new medication. She freaked out and demanded to stay on Concerta, saying she needs it to concentrate. She wasn't even open to a discussion about it. I told the doctor to tell my difficult child that if she is not medication compliant then I would not pick her up for a home visit. (if she ever behaves well enough to warrant a visit) The doctor wants to try Strattera to address her ADHD and a new mood stabilizer, she couldn't remember the name of it, is starts with a Z. She is going to call me back and let me know what it is. They don't want to try Lamictal as it is really for the deppressive state and not so much for mania. Well that's what she said anyway. So now we are just waiting for my daughter to agree to the medication change. Hopefully soon. Like today!!!

I told the doctor to make sure she tells my daughter that the Strattera also has a loss of appetite effect as she is very concerned about gaining weight. She put on 30 pounds with the last medication combo. (which did not include Concerta)

I'll keep you posted. Thank's for listening. :smile:

 

[DammitJanet]

There is a new mood stabilizer out? News to me.

The only thing that starts with a z that I know of is zyprexa and your daughter will hate it. It causes massive weight gain. Its also not a mood stabilizer but an antipsychotic which they use for short term control of mania.

I can understand them not using the lamictal if she doesnt show depressive states. They may have to control the manic sides to her and the anger and irritability. Sometimes it does come down to treating symptoms.

 

[smallworld]

Lack of concentration can be from mania, depression, anxiety, etc. It doesn't necessarily mean ADHD. I'd be concerned about Strattera because it's an antidepressant and can exacerbate mania. Even in kids who don't have BiPolar (BP), it can cause mood swings and make kids downright mean.

Have you read Chapter 4 in The Bipolar Child about the medications used to treat BiPolar (BP)? If not, you might want to get your hands on it.

 

[branbran]

Smallworld,

You are so right, it just dawned on me, my nephew took strattera for a few months for his ADHD and he was very irritable and down right nasty!!! I forgot all about that until you mentioned it. So thank you. When the doctor calls me back, I'm going to tell her I want my difficult child to start the new mood stablilizer alone, no other drugs. Wait a few weeks and see if it makes a difference. If she takes the Strattera and it gives her the same effect as the Concerta - how the heck are we going to know if the mood stabilizer is working?

I do have the book "The Bi-Polar Child", and just took it out and read chapter 4. I have referred to this book as my Bible for the past 3 years. I knew about the effects of the stimulants, but was unsure about the Strattera as it is a non-stimulant.

I'm so glad you mentioned the meanness from the Strattera, you saved my poor difficult child from more irritability. THANK YOU!!!!!

 

[Steely]

Yeah Bran Bran - Strattera in combo with Celexa is a BAD idea in my mind as well. That would be 2 anti-depressants and NO mood stabilizer. I would not let them try the "new mood stabilizer" either until you research it. I am with Janet, the only medication I know of that starts with a z is Zyprexa - and I would not suggest that medication. Good grief, my son was ready to eat the plaster on the wall his appetite was so out of control, he acted as if he had never eaten in his life!

Interestingly, I just did a google search with the key word "new mood stabilizer", and guess what the top hits are - Zyprexa!!! Weird - it is not a mood stab. but an anti-psychotic - but apparently some doctors are touting it now as the new bi-polar mood stabilizer. Weird, weird, weird!!!!

Keep us posted, and I will be hoping you can find the right one. Just FYI, my son has mostly manic features of the bi-polar, but they wanted to try Lamictal, because overall it helps even out the rough edges of the drastic mood swings, which is sounds like your daughter has a lot of. Lamictal seems like a safer choice to at least try than Strattera.......there is no weight gain, and there is a low rate of sleepiness associated with taking it.

 

[DammitJanet]

Let me ask...does your daughter have a weight problem to begin with?

One of my biggest issues in dealing with my bipolar is the weight gain potential of the medications. I am already morbidly obese and I have degenerative joint disease so putting any more weight on my worn out body just isnt good for me. I am staunch in my position that I will not take anything that has much of a chance to do that to me.

I run from the antipsychotics like the plague. I have taken low dose seroquel at times but I am loath to do it. My treatment of choice is lamictal and topamax. The lamictal helps me with the depressive end and the topamax helps me with several issues: weight, mania, and nerve pain. Unfortunately it isnt as effective with the weight anymore since they took me off it and restarted it but it still helps with the mania and the nerve pain so Im still on it.

 

[Steely]

Just saw your other post - and had to comment again.......I would not believe your daughter only has conduct disorder for a minute!!!! :mad:
What is this Residential Treatment Center (RTC)'s speciality anyway? Because it sounds like they really have put her in a box before they have thoroughly analzyed her!

Bi-Polar can manifest itself in SO many ways, it is ridiculous for them to rule it out at this point. Furthermore, as long as she is on this medication combo, thay cannot diagnose her! Anti-depressants can cause all sorts of psychological reactions, including CD, and the only way they will be able to tell what is going on is when she is off these types of medications.

Grrr......sorry to be so forthright, it is just so frustrating the way doctors throw around their opinions as if they are a God.....and then we as the layman parent have to first not freak out about their callous calculations, and second spend the next ten days trying to find out where the real truth resides!

Trust your gut - you know your baby daughter more than any one person! Trust your instinct, and don't ever doubt your what you know to be your truth.

 

[Sara PA]

Now wait....the psychiatrist is keeping the Lexapro (antidepressant) and wanting to add Strattera (antidepressant) but rejects Lamictal because it's the only mood stabilizer that addresses depression? And s/he's just ignoring that antidepressants can cause mania? Something's not right there.

While I'm reasonably sure the psychiatrist is trying to pass Zyprexa off as a mood stabilizer, there is an anticonvulsant called Zonegran which has been prescribed off label as a mood stabilizer. It causes cognitive dulling on par with Topamax and it isn't a recognized mood stabilizer.

 

[waytootired]

I can say that coming off antidepressants nearly put an end to our family. The AntiD just wasn't enough anymore for my son,(11 yrs. old)and we now know he is more than likely Early Onset Bi-Polar (EOBP), not just depressed. He became delusional, violent and really mean, holding knives to us, cussing at us, destroying rooms, throwing furniture, the whole bit. (He was on Effexor). It took a solid week and a half, someone with him 24/7 to get it out of his system. (And this was coming off slowly, not cold turkey).

In the mean-time,(no pun intended), he started Risperdal and WOW !! it was day & night difference. He has been on this medication for 9 months and really doing well. He now reminds us it's time for his medication because he likes the way he feels. I can say that I love him again.

 

[branbran]

Sara,

That's it!!! It's not Zyprexa it is Zonegran. The doctor could not remember the name of the drug, she said something that sounded like it ended in the letter N. Oh, thank you. When I researched mood stabilizers that began with the letter Z, I thought it had to have been Zyprexa, as Zonegran never came up. After I read about Zyprexa I was thinking "What is this doctor crazy?". Thank you so much for letting me know this info!!! God - I always learn so on this site.

 

[Sara PA]

That's ridiculous. If s/he's at the point of trying Zonegran as a mood stabilizer, s/he should be removing the drugs that cause mood swings and certainly not be adding Strattera which says in its commercials that it causes mood swings. Mood swings are a common reaction in children to Strattera. [ETA: FDA Medication Guide listing "mood swings" as a common side effect of Strattera: http://pi.lilly.com/us/strattera-ppi.pdf )

waytootired-- the first two weeks off an AD are the worse, but the side effects go on for months as the body readjusts to not having it in the system. Effexor and Paxil are indeed considered the worse though I've heard more stories of violence (or potential violence) with Effexor.

 

[branbran]

Waytootired, great news for your son! Life is good when our difficult child's are doing well. When the children agree to take their medications, or in your case, even better, they want to take their medications, life is a little easier for us moms.

Thanks for the advice. :smile:

 

[BusynMember]

Zonegran isn't proven to work as a mood stabilizer. I don't know why she's going there. Straterra is an antidepressant, which is why it makes bipolar kids worse. I wouldn't want to even address ADHD. in my opinion the bipolar is a bigger issue, just get that under control. You can't concentrate when your moods keep swinging. I would want to try one of the first line, proven mood stabilizers: Lithium, Lamictal, Trileptal, Depakote or Tegretal. There are no other first line mood stabilizers. You would need eight weeks at a therapeutic dose and NO stimulants or antidepressants to see if it is going to work or not. Good luck!