bipolar questions

[klmno]

For those familiar with bipolar, could a 10-11 yo be triggered into major depression (1st time), then go into a manic state for 2-3mos., then be stable for 8-9 mos., then go into major depression for 1-2 mos., then manic state for 1 mo., then appear to be cycling back and forth every 2 weeks? Does this sound more like ineffectively treating major depression (unipolar), or bipolar, or some other uncontrolled mixture of depression and anxiety? Yes, he was on prozac, he was put on it about the 2nd mo. of the first "manic period" until the beginning of the 2nd "manic" period, so I'm not sure that it caused the 2nd one- maybe contributed to it though. I wanted to ask psychiatrist but had too many other issues to discuss.

 

[BusynMember]

I think you'd have to see how his moods are without the Prozac. Prozac can do weird stuff. Depression, from my experience, tends to linger for long periods of time and doesn't remit. In fact, it's pretty stubborn and debilitating. My won depressions took up to a year to go away before I'd snap into mild highs. My first diagnosis was major depressive disorder (at around age fourteen), but it was changed to "manic-depression" when I was hospitalized and the Psychiatrist learned I tended to snap into little "highs." BiPolar (BP) is often very hard to see or to tell apart from major depressive disorder. Anxiety was a huge part of my mood disorder too.

 

[klmno]

Thanks, Midwest! I had been under the impression that childrean and aloscents would cycle more quickly than adults, but now I'm wondering if it always starts out that way, and if some "blips" in mood swings that didn't escelerate into crisis might have been a sign of a little cycling going on. I know we cannot diagnosis it here, and docs will loook into it, even if it takes years before they can list it on paper, I just desperately want to hurry up and help him. psychiatrist has him off all medications right now so we can see what's going on at base level. We're seeing psychiatrist every 2 weeks thru this, but it is frighttening and painful to see my difficult child like this.

 

[Alisonlg]

The guessing game is terrible, isn't it? I feel your "hurry up and wait" pain! ::::::

 

[smallworld]

klmno, when you say your son was "triggered into major depression (1st time)," what triggered him? Or did he get depressed on his own?

This is the course my son followed: He became anxious and depressed. The psychiatrist prescribed Zoloft. After 3 weeks, difficult child 1 began to rage -- trash the house, break windows, go after family members aggressively. We had never seen this behavior before in this child. The psychiatrist immediately took him off Zoloft, but difficult child 1 didn't settle down on his own. After 6 weeks of nightly raging, the psychiatrist prescribed Depakote. After 6 weeks on a therapeutic dose, the raging stopped dead in its tracks. However, he went back to being depressed, and while better on Lamictal and a low dose of Lexapro, we're still working on that symptom (we're going to make some medication changes this summer while school is out).

The problem with knowing exactly what's going on is that it is estimated that 30 to 50 percent of children who initially present with depression actually go on to have bipolar disorder. In addition, "raging" is not synonymous with BiPolar (BP). Raging can occur in other disorders such as anxiety and depression.

 

[klmno]

What kind of medications would be used for depression and anxiousness that is not bipolar?

 

[smallworld]

Antidepressants -- the SSRIs (Prozac, Zoloft, Celexa, Lexapro, etc), the SSRI/SNRI combos (Effexor and Cymbalta), the tricyclics (Amitriptyline, Nortriptyline, etc) and Wellbutrin (although it does a better job with depression than anxiety).

What triggered his initial depression?

 

[klmno]

Teachers had been saying he was headed for dentention center (he'd never broken a law at that point) and other inappropriate things to him in front of his peers. Same time period, he comes to understand that the reason his father wasn't in his life and that they had never met or spoken, was because his father had wanted it that way (son now has major rejection issues) and he clearrly internalized that all this was just because "he was bad". On top of that, a family friend (grandmother's best friend) was starting treatment for breast cancer and they found spots on my mammogram. Everyone had been assuring difficult child that this is treatable and typically cured, but family friend died shortly after 1st chemo treatment. It took a couple of months before we found out that I did not have cancer. All of this happenened between Sept. and Dec., 2005. At first, I saw signs of sadness and big issues with "I'm just bad and can't help it". Then, he started being non-compliant, angry with me, and stealing things. I had started family therapy for us, but he became more erratic and a clear danger to himself and giving away toys, etc., so I got him in an acute psychiatric hospital where they said major depression, rule out bipolar, and put him on prozac.

 

[smallworld]

So his depression was not caused by medications at all.

And then the mania started after Prozac? Or did he do better on Prozac?

 

[klmno]

The first medications he ever had for mental health was the proza prescribed by the psychiatric hospital, approximately 4-6 weeks after erratic behavior started.

 

[klmno]

Also, the prozac seemed to be what was keeping him stable until early this year, when I saw signs of depression coming back, then psychiatrist increased prozac dosage, sd put difficult child on long-term suspension (thru end of school year), then my difficult child went on a 2-hour crime spree, which is why he is in detention right now. After the 2-hour crime spree, psychiatrist immediately stopped the prozac.

 

[smallworld]

How much Prozac was he taking when he went on the crime spree?

 

[klmno]

He had always taken 10 mg/day (very low dose), then he was increased to 20 mg/day. Being a boy at this age, psychiatrist and I had thought the growth spurts, hormonal changes, etc., had caused the lower dosage to be ineffective. He was on 20 mg/day for ten days prior to crime spree. Also, there had been some escalation in bad behavior, along with depressive symptons, before the dosage increase. The sd "rejection" happened 3 days before the crime spree. In my mind, the ineffective IEP, where sd approached behavior intervention by telling us "one more violation, you're out", then actually following thru with that, triggered this. I don't know if the crime spree would have happened or been as bad if he had been on a medication other than prozac, but I'm not convinced that it caused it. Also, I might just be "looking for things" too closely now, but since being off all medications (2-3 weeks), I think I;m seeing cycling in him.

Something else, he's starting to discuss things he notices about himself with psychiatrist. These include: there are periods of time when he doesn't feel pain normally and that lately he can't sit still, has to be moving and doing something constantly. (There has never been any history of ADHD with him).

 

[Steely]

As you know klmno, it is so hard to actually diagnosis kids at this age. I had a feeling my difficult child was bi-polar from age 4 on because he had rapid mood cycles throughout the entire day and his father was bi-polar. However, the doctors did not want to diagnose him with that until he was showing actual signs of mania, which started pretty abruptly when he was around 12. From what I have read, puberty is when most bi-polar patients start to show more classic signs of bi-polar, but up until that point bi-polar can manifest itself by making the patient excessively moody, or depressed, etc.

So to answer your question, your son could have bi-polar that is starting to show more classic signs as he matures - or he could have suffered mania induced by prozac - or any other of the myriad of mood disorders. It is just such a cr@p shoot, and so hard to really know. Regardless, the Dr should be able to trial some other non SSRI medications with him, to see if those help with his mood regulation issues.

 

[klmno]

Thanks, All!! As most of you feel, I don't really care what label they put on it, I just want the right treatment and if the "label" is too far off base, then the sd, tdocs, etc., sometimes insist on dealing with difficult child a certain way that really makes matters worse.

 

[OpenWindow]

Bipolar is in my family, and difficult child has mood swings, so this is one of the first things his old psychiatrist looked at. (We chose this psychiatrist because he was a local expert on children with bipolar.) Even with the mood swings, rages, etc., the psychiatrist "ruled out" bipolar.

It's so hard to tell. difficult child has many signs of bipolar, but also of asperger's, Pervasive Developmental Disorder (PDD), odd, adhd, the list goes on.

My difficult child did awful on prozac - got very mean and violent the second night. We stopped it immediately. Zoloft worked until he started getting tics. Lexapro has seemed to be working the last few years. Now that difficult child is getting close to puberty, the psychiatrists are re-evaluating him again for bipolar, among other mood and thought disorders, and asperger's again.

It's so hard to tell whether the kids are reacting to the medications or to the things that life throws them. My difficult child is always the worst in the spring - is it biological or is it because the schedule at school turns upside down, or is it because he is outgrowing his medications?

My difficult child takes Lexapro for anxiety and to help with "rigid thinking." He's never been diagnosed with depression although he is either in a really good mood, or a really bad mood.

 

[Sunlight]

klmno
I have to say I love your avatar. it makes me laugh every single time I see it! I thought it was a couple but now know it is a mother and child. lmao