Bye-Bye Tenex & psychiatrist3 said Bipolar!!!

Discussion in 'General Parenting' started by totoro, Sep 28, 2007.

  1. totoro

    totoro Mom? What's a GFG?

    Well I had a long talk with psychiatrist3 tonight. I had everyday written down and just started reading them off and K's rxn's since starting Tenex!!!
    I then explained my fears about trying to treat the ADHD symptoms etc. "I would really like to focus on mood stability"

    He actually said "well with a child with K's Bipolar and her severe anxiety..." Prior to this he had never really said it, he said he would treat her as if she was, and take her previous diagnosis's. But I think he realizes what is going on now... I hope.

    Anyway he explained his reasoning, he is hesitant to try another AP, due to her Dystonia/movements/weight gain, which has been more than 5% of her body weight. He is very concerned about her Anxiety and feels part of stabilizing her is calming her anxiety, he had used Tenex to help calm kids before. So now he wants to go a couple of days let her calm down a bit and then add the Nuerontin. He acknowledges that this is not the "best" for BiPolar (BP) but it is good for anxiety and with the Lamictal and maybe Nuerontin he is hoping we can stop the Abilify and see some calm for her...
    He doesn't want to add an AD, but says maybe, once we get the Lamictal where we really want it. We are going to 175mg now. I think he said he wants to go only to 200mg.
    He said he knows this is hard and knows i want her on as few medications as possible... He feels uncontrolled anxiety can send a BiPolar (BP) person out of control even more. Which I have read and I agree with, my anxiety makes my moods much worse!!!

    Anyway that is my update, I appreciate any advice or input, thought... :thumbsup:
  2. smallworld

    smallworld Moderator

    Hi T, I don't think there's any problem with trying Neurontin because it is an anticonvulsant like Lamictal and certainly shouldn't send K into mania the way an AD could. However, I've read that Neurontin isn't effective for mood stability and may not be all that great for anxiety either. But I do know a family with two BiPolar (BP) kids who have done very well on Neurontin. So I think it's worth a shot.

    How are K's hallucinations on the current dose of Abilify? I'd be concerned that they'd come flooding back if you discontinued the AP altogether. No anticonvulsant will treat hallucinations.

    Good luck. Let us know how it goes.
  3. Sara PA

    Sara PA New Member

    Two anticonvulsants aren't unusual. I've heard Neurontin being helpful for in short run for anxiety but that it seemed to wear out over time.

    From the Neurontin prescribing information:
    Neuropsychiatric Adverse Events; Pediatric Patients 3-12 years of age

    Gabapentin use in pediatric patients with epilepsy 3-12 years of age is associated with the occurrence of central nervous system related adverse events. The most significant of these can be classified into the following categories: 1) emotional lability (primarily behavioral problems), 2) hostility, including aggressive behaviors, 3) thought disorder, including concentration problems and change in school performance, and 4) hyperkinesia (primarily restlessness and hyperactivity). Among the gabapentin-treated patients, most of the events were mild to moderatein intensity

    Considering that Lamictal seems to cause hypomania sometimes, this may not be a good combination.

    Anyone hear anything about Gabitril lately? It was being trialed for anxiety but I never heard anything more. Oddly it has a warning that it can cause seizures in people without epilepsy.
  4. pepperidge

    pepperidge New Member

    HI Totoro,

    well it sounds like you are making some progress, of sorts, I guess.

    difficult child 1 has really been helped by Lamictal. It takes it with a relatively low dose of Topamax, which I keep trying to take him off of, but it seems to also kick in and help with mood stability so for the moment he is on both. Before we got to Lamictal we tried Neurontin, it didn't do much, but maybe we would have seen an effect if he had already been stabilized. (He probably isn't a true bipolar though, but that's another discussion. Lamictal does wonders for his depression).

    He does have serious anxiety, though. For us adding a small amount of Risperdal seems to have done the trick, he has never had an negative side effects to it. Abilify was not helpful.

    Ever since the beginning he has take a very small dose of Adderall. It makes him so much more pleasant and is key to schoolwork. The Adderall and Risperdal seem to balance each other out.

    Anyway, I hate having him on all these medications, but he has been very stable now for over a year. This year he is actually going to school full time (at least right now!). We started medications in third grade, and it took us until the sixth grade to get it right. I toy with trying to reduce the dosages, but really don't want to do anything to jeopardize what we have. Puberty is coming soon enough anyway.

    None of this probably helps you, but I just wanted to let you know that I wonder how you guys are doing almost every day and hope you find something that works pretty soon.

  5. flutterbee

    flutterbee Guest

    I'm glad the psychiatrist listens to you. You seem to have a good working relationship with him. That's worth a lot, which I'm sure you know...especially after your other psychiatrist experiences. :faint:

    Speaking from experience, I totally agree with psychiatrist regarding the anxiety. With my difficult child, her anxiety controlled everything else and made it 10 times worse.

    Crossing my fingers that the neurontin works.
  6. totoro

    totoro Mom? What's a GFG?

    Thanks everyone-
    I know I need to be patient, I have read a couple of things from different BiPolar (BP) books etc. that really hit home the need to help the anxiety. I have also read that the Nuerontin has helped with the anxiety... I know it may not???

    I really think he cares (psychiatrist) and wants to help... K has been a mess this week. Tonight she was so UP... She is trying to plan a party... here we go! Rambling, hyper, moving non-stop...

    I am to call psychiatrist Tuesday and we shall see? Maybe a new medication, he wanted to give me time to research it and make sure insurance covered it? He said not alot of insurance covered neurontin?
  7. flutterbee

    flutterbee Guest

    I wonder how much of K's behavior that is being attributed to mania is actually anxiety. When difficult child was K's age, her anxiety looked a lot like what could be described as mania or hyperactivity. She moved non-stop. Dinner time consisted of a bite of food and a trip around the table over and over again...for the entire meal. If she was watching tv, she was never just sitting on the couch, she would have her feet on the floor and would be bouncing up and down the entire time. It was also non-stop chatter and just bouncing from thing to thing.

    I'm not saying she's not experiencing mania, but if her anxiety is that high, I can see how it could make the mania seem worse. Does that make sense?

    I just realized that I've missed two doses of my lexapro and my thoughts are scattered...having a hard time getting my point across.
  8. SRL

    SRL Active Member

    My experience with difficult child and mania was similar, wyntersgrace. When he went over the edge anxiety-wise, it triggered manic episodes which we'd never seen before. Once the anxiety was under control, it stopped being the norm and only makes rare appearances during rages.
  9. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm glad the psychiatrist is on the same page as you. He seems like a good guy. Lamictal has helped my difficult child but for him that is not. He is also taking Topomax which helps a lot. The AP that difficult child is on is an older one-Loxapine. For him it has been great. He did not have a lot of weight gain with it and it was one that our psychiatrist felt comfortable with since the Abilify had caused the TD. He also didn't do well on Seroquel or Respirdal. Just sharing what has worked for him.
  10. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I think you have a darn good psychiatrist who understands both the medications and how anxiety affects mood stability.He's a keeper. Just hang in there.
  11. TerryJ2

    TerryJ2 Well-Known Member

    I have no advice but wanted to send my support.
  12. susiestar

    susiestar Roll With It

    Glad things are working out, relatioship wise with psychiatrist. That is worth it's weight in gold.

    As far as neurontin, have you or psychiatrist investigated Lyrica? My daughter's neuro, and my rheumy, both say it has a lower side effect profile. It is the "next genreation" of neurontin. I take it for the central nervous system problems with the fibro. It also prevents my migraines.

    My daughter does not take it at this point, but her neuro has discussed it with us as a possible if what she is on quits working.

    I hope you get the anxiety and other stuff under control.


  13. totoro

    totoro Mom? What's a GFG?

    Thank you Susie I will write that down!!! I am writing down all the advice, medication advice etc. So I have it straight when I talk to him and ideas!!!
    Sorry I can barely type I have a cat booty in face and across the keyoard... :pet:
  14. Sara PA

    Sara PA New Member

    Originally Posted By: totoro
    He said not alot of insurance covered neurontin?

    Probably because of the whole fraudulant marketing thing. Because the sales reps touted it for everything and anything and many doctors were convinced the studies existed, it was prescribed for lots of things it didn't help.....and in high doses when it was (and still is?) an expensive drug.
  15. Our difficult child has been taing neurontin for four years for control of neuropathic pain. I don't know that we have seen any mood stabilization with it. However, he has had a few side effects that I would suggest that you watch for....

    He has periodic episodes of fainting or near fainting. The first time we took him to the doctor and he did an ekg. He finally decided it more than likely is a side effect from the neurontin. difficult child is now more in tune with his body and sits down if he feels dizzy.

    Neurontin is really tough on teeth. After a shocking episode of serious, sudden decay in one of difficult child's front teeth (his first cavity ever - and it required a root canal and crown) , the dentist is working closely with us. difficult child uses two special toothpastes - one that stimulates salivia and one that is a prescription level of flouride. He also gets checked every 3 months. This has been working thus far. Many of my clients at work take Neurontin for neurogenic pain and almost all of them have serious dental issues.

    I do believe that the neurontin has affected difficult child's school performance and definitely his short term memory. His 504 plan addresses the memory problem. We really have no choice regarding this medication due to difficult child's phantom pain . I think if we did have other options I would choose another medication - particularly because of the dental problems.