Bipolar medications?

Discussion in 'General Parenting' started by branbran, May 28, 2007.

  1. branbran

    branbran New Member

    Just wondering if anyone has any suggestions as far a good mood stabilizer. I know it's really a personal thing, everything doesn't work for everyone, but the docs haven't been able to get it right as of yet - almost 4 years of trial and error. My difficult child has been on Lithium, Trileptal, Depakote, Geodon, Seroquel, Abilify, Risperdal, Topamax, Concerta, Lexapro and I'm sure I forgot a few. She hasn't tried Lamictal, anyone had any success with that? She also suffers from depression and ADHD as well as the Bipolar. This medication maze is so frustrating. I feel like we are never going to get it right!!! She now has gotten a Conduct Disorder diagnosis. I have learned (from this site) that that diagnosis is usually just poorly treated Bipolar. She has never even had a brain scan or an EEG. I have pushed for the right tests for so long, to no avail. Everyone says she doesn't need them. She has been hospitalized 8 times and has made no headway at all. I'm hoping she will recieve the proper testing now that she is in a good Residential Treatment Center (RTC). I'm waiting to hear from the doctor. In the meantime this poor kid is suffering as she is only on Lexapro, Concerta (which makes her miserable) and Geodon. No mood stabilizer. She will be changing her medications, hopefully this week.

    Any suggestions? Can anyone tell me what tests she should have had? According to all the "professionals" I've ever dealt with, she would not benefit in any way from any type of brain testing. That doesn't make any sense to me. Let's at least rule out as much as we can - Right?

    Thank you for any advice :smile:
  2. smallworld

    smallworld Moderator

    My difficult children, whose symptoms are largely depressive but react aggressively when given SSRI antidepressants on their own, have done very well on Lamictal. But you are right -- it is very individual how the patient will respond. Unfortunately, it is still very much a trial and error process.

    The one important aspect of treating bipolar disorder is to put the mood stabilizer (Lamictal, Lithium, Depakote, Trileptal, Tegretol) down first, attain a therapeutic level for 8 weeks and then assess what residual symptoms persist. In your shoes, I'd want your difficult child weaned from Lexapro and Concerta and see how she does on a mood stabilizer on its own. No mood stabilizer or atypical antipsychotic will be able to counter the bad side effects of either an SSRI or a stimulant. As you probably know, both SSRIs and stimulants can make adolescents with BiPolar (BP) much, much worse.

    There are very helpful treatment guidelines
  3. smallworld

    smallworld Moderator

    To answer your question, any adolescent with significant mental health issues should have an MRI and an EEG to rule out brain structure abnormalities and seizures. In addition, neuropsychological testing to assess cognitive and psychological functioning is very helpful in a case like yours.
  4. crazymama30

    crazymama30 Active Member

    My difficult child does well on Lamictal, but awful on Lithium and Depakote, and does not tolerate stims alone. Good luck. I myself would never put difficult child on stims alone, and would be leary to do it while on a mood stabilizer.
  5. Steely

    Steely Active Member

    Yeah I agree with crazymama - your daughters medication combo now is a scary one if she is Bi-Polar. I would NOT have her on any stims.......and only on Lexapro after she is stable on a mood stabilizer. No wonder the poor thing is miserable, her mind is probably racing.

    As far as medications, it is hard. We have also tried everything, and are down to only a few medications left to try. We are trying Lamictal, which has gotten some very good results for a lot of people - but so far I have not seen any improvements. I don't think we are on the right dose yet though - it takes a long time to titrate up to the correct dosage.

    The other medication we just tried is Clonidine..........and boy! I have seen major improvements with that! It quells my son's anger like no other medication we have ever tried! It is awesome! He is a happy, calm person on this medication. The thing about Clonidine though, is that it is not a mood stabilizer, per se. So, it would need to be used in conjunction with something like Lamictal.

    Also, you might not rule out trying one of the previously tried medications. Our kids bodys grow and change, and what was not helpful 5 years ago, might be helpful now.
  6. TerriH

    TerriH Member

    My daughter is doing well on Lamictal.
  7. Kjs

    Kjs Guest

    Lamictal has worked great with difficult child. We had a rough spout in January, situations and changes in the home, psychiatrist added Lexapro and that from day 1 caused very noticable issues. Then he added remerom to help him sleep, only that made him even worse. I believe in april we discontinued everything except Lamictal and topomax. the topomax was prescribed by neurologist to help control his migranes. I do not think that is working and am about to see if that can be removed also. Lamictal alone he did great, but still had some anxiety issues. Afraid to try any other medications since we still seem to be recovering from the last change.

    Hope you find the correct medication for your difficult child.
  8. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    The only way you can know if the medications you've already tried don't work is if she was on them for at least eight weeks, at a therapeutic level, WITHOUT also taking stimulants or an anti-depressant. Both stims and anti-depressants can make it impossible for mood stabilizers to kick in. Also, less than eight weeks long just isn't enough time, and a too-low dose won't work either. It will be the same with Lamictal. That also takes eight weeks at least to kick in and if she's still on Lexapro and the stimulant, she is probably not going to respond the way you like. I can't imagine how hyper she must be on an antidepressant and stimulant. Almost everyone with bipolar has some depression, but anti-depressants can kick bipolars into rageful, aggressive, even psychotic mania. You need to make sure all the mood stabilizers were tried for a long enough period of time, at a high enough dose, and for the adequate length of time or you don't really know if they will help your child or not.
  9. branbran

    branbran New Member

    Thank you all for the input. The problem with the medications is her Residential Treatment Center (RTC) thinks she is just Conduct Disorder and not BiPolar (BP), I disagree. She has seen plenty of docs in her day and has been hospitalized 8 times at 2 different hospitals and everyone agrees, she is BiPolar (BP). So now I must convince the doctor at her Residential Treatment Center (RTC) to at least be open to try a mood stabilizer without the antidepressent or the stimulant. Not going to be easy I imagine. I am also going to mention Clonidine. I read about that and thought my daughter my do well on it, but she hasn't tried it yet. She isn't medication compliant. She only wants to take Concerta, of all things!!!

    I will keep you posted. Thanks again :smile:
  10. Sara PA

    Sara PA New Member

    Sure she wants to take Concerta -- it's speed. The stims are now street drugs and kids with no diagnosis want to take them.
  11. busywend

    busywend Well-Known Member

    I agree with SaraPA - of course she is willing to take the Concerta. It does make her feel good - it makes her feel high I bet. Not high like smoking marijuana, it is different.

    The hard part for you is going to be tip toeing around the professionals with the knowledge you have gained here. Your best bet is to document all the medications she has tried, for how long she was on them and what the reactions/side effects were. Alot of docs will turn you into the crazy mom if you know too much. I know, it seems ridiculous, but I have seen it happen.
  12. guest3

    guest3 Guest

    my son finally had MRI this past Sat. I had to go to a neurologist on my own as psychiatrist refused to order tests. Neurologist sounded skeptical that they would find anything based on difficult child II's history but we should hopefully have the results this week sometime. It was very hard to find a neurologst (in my area) that would even see him because he is bi-polar.
  13. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I have bipolar and all sorts of weird neurological problems (processing, organization, etc.) and I had a CT scan--nothing showed up. Nothing will show up if it's a psychiatric or even if it's autism or other harder-to-detect neurological problems. Unfortunately, there are no tests to nail what's what yet :smirk: I've been extensively tested and there is no doubt I have severe Learning Disability (LD)'s, especially a huge NonVerbal Learning Disorder (NVLD), but the CT scan still came back normal, as they'd expected it to. I think the neuropsychologist testing I took was far more accurate (I was forced to have an evaluation when I wanted to work with Job Services for employment, as I have trouble keeping jobs--can NOT multi-task).