day 3 lamictil

[jannie]

Well-we decided to put difficult child 2 on Lamictil. I feel guilty about trying a new medication because he's already on two....but he's still not where he should be. We've been struggling with this decision for over a year.

Basically, I feel like difficult child 2 is on the manic side..he's been getting more hyper all week-non-stop singing.. I know that lamicitil can be beneficial for dealing with depressive qualities, but does it help with mania? difficult child in general is much more hyper than down...but he does get really down and overhwelmed..

I hope I made the right decision in deciding between Lamicitil versus trileptal. I do know that smallworld mentioned that sometimes the kids get a bit hyper while increasing medications..but he was already hyper.

 

[smallworld]

Jannie, if he was already hyper, why didn't you take him off Lexapro and Vyvanse before adding a mood stabilizer? You may not get a true idea of how well Lamictal will work for your difficult child if you don't discontinue the other medications.

Lamictal is an activating mood stabilizer, especially at the beginning of each medication increase. While it is approved for the long-term treatment of bipolar disorder and has robust mood stabilization properties, according to our neuro, it tends to work best on the depressive end of the mood spectrum. Depakote is probably the best mood stabilizer for mania.

 

[jannie]

I don't know why we didn't stop the lexapro and vyvanse...I guess it's because he's only on 5 mg of lexapro...and it is such a small amount.

I believe he shows symptoms of both hypomania and some depression. Over the past year or so we've seen more and more hyper...which is why we started vyvanse.

Why are you saying that we can't get a true idea of how well it works...the plan is once it settles in we could try to discontinue the lexapro...or one of my doctors said he could stay on it if we feel it helps.

Just last week he was so much calmer...but then things increased which is why we finally decided to trial it.

What does "activating mood stablizer" mean?

I do think he's more hyper than depressed, but I do feel the lexapro helps with anxiety and depression issues.

 

[pepperidge]

Jannie,

I had a anxious, depressed, but silly kid. The doctor put him on Lexapro. It was a disaster. he started turning over desks. Another doctor tried Prozac. It made him very disinhibited (stealing, fire-setting, impulsive, very silly). We then got a psychiatrist who knew something about mood disorders. After a trial of Trileptal (which had bad effects) we tried Lamictal. It really helped the depression. But he was off all anti-depressants. We kept the Adderall because it helped tremendously, and we saw that because he was first on Adderall and only Adderall, but alone it had some nasty side effects. I would really really question your psychiatrist about keeping your kid on both lamictal and lexapro. Why don't you see what Lamictal does by itself? Have you ever tried a stimulant by itself? Did it have good effects?

good luck
P.

PS after all the bad experiences we went very slow on Lamictal, 12.5 increase a week, which is much lower than recommended, but made me feel more comfortable and we had no side effects.

 

[smallworld]

Both stimulants and antidepressants can destabilize the mood. A mood stabilizer sometimes can't work its magic against the destabilizing forces of stimulants and antidepressants. We have always started the mood stabilizer first and then added stimulants and antidepressants later if necessary. In my son's case, he can't tolerate either stimulants or antidepressants, even with mood stabilizers on board.

Hyperactivity can sometimes be hypomania/mania in disguise. Stimulants can make hypomania/mania worse.

An activating MS means that it gives energy or lifts the mood. In some cases, Lamictal needs to reduced in the spring to head off hypomnia/mania and increased in the fall, when depression can set in. I've seen Lamictal lift the moods of both my son and daughter, who fall on the depressive end of the mood spectrum.

 

[jannie]

We never did stimulant alone. I know that in the early fall he was on zoloft and it made him totally hyer/disinhibited...falling out of chairs and had a very bad reaction to withdrawl.

I do think the vyvanse helps him and the feedback from the school has been quite positive....and for some reason I never ever skip a dosage...I guess I feel like he's always so hyper so he needs the medicine...a few weeks ago we skipped our first dosage..but I think he was manic then...so when he had no medicine he was really really hyper. Since that time we reduced the lexapro from 10 mg to 5 mg...with the reduced lexapro he settled down some..and he's been calmer and not as impulsive...that lasted a few weeks and now once again he seems revved up....which is why I think it's some type of mood disorder.

 

[Sara PA]

No, 5 mg isn't a small dose of Lexapro. The recommended dose of Lexapro is 10 mg. That's for adults, of course, because it isn't safe or effective enough on kids for it to be approved for use by kids so there is no child dose.

Ten mg of Lexapro is the equivalent of 40 mg of Celexa. Twenty mg of Celexa (the equivalent of 5 mg of Lexapro) was enough to not only make my son manic, it made him psychotic. Don't be fooled just because Lexapro is concentrated.

Mania is a psychiatric side effect of the drug. Even if a drug is working for the reason it has been prescribed that doesn't exclude the possibility of the person taking it suffering from a side effect. On the other hand, it may be all side effect that you are seeing. Certainly triggering hypomania or mania would make it look like a drug has reduced depression and anxiety.

If indeed he is having a manic reaction to the Lexapro -- which will continue to get worse the longer he takes it -- there is no drug he can take which will fix it. My son was taking 400 mg of Lamictal and it didn't do squat to stop the bad reaction to the Celexa. He continued to get worse until the day he threw the Celexa away.

Lamictal is called an activating mood stabilizer because, though it helps decrease mood swings or bipolar episodes over the long run (which is what a mood stabilizer does), it can and does cause some mild mood elevation (which is why it is usually given to people on the depressive side).

 

[amazeofgrace]

lamectal and trileptal both made difficult child II very nasty, I actually have Trileptal for difficult child I but am afraid of giving it to him, because of the effect it had on difficult child II

 

[Sara PA]

Are you saying he wasn't hyper and didn't need a stimulant to settle down until he was on an antidepressant for a while?

 

[jannie]

difficult child has always been hyperm but manageable. He's is very bright and excelled in school so he was able to keep up with the work and get things done.

As he got older I noticed that he had a really hard time sustaining is attention and beame easily frustrated when things were a bit challenging. He was unable to persevere and work things out...writing in general and writing in resonse to reading was becoming more and more challenging. He also was having a hard time putting thoughts on paper or even coming up with ideas...He was always impulsive...I always did my best to put him in a class with the most structured teacher. Homework time was a struggle but the work was easy for him so we battled just to get it done.....As time went on he has been getting more angry, more frustrated and more agitated.

We didn't start with a stimulant because I was really concerned about tics and Tourette's Syndrome. I did not want bring out something that could quite likely be in his genes. So we waiting as long as we could. The anger/frustration along with hyper/anxious/impulsive were big symptoms.

Here the order of medications:
Gr. 3 tenex (2-3 months)
Gr. 4
straterra (three weeks)
abilify ( six months)
nothing
Gr. 5
zoloft (25-50 mg)
Vyvanse (20 mg)
Lexapo
Lamictil

I do think the zoloft/lexapro has made him more hyper...which is why we cut it back...but I do think it has helped with anxiety.

This morning...I did not give him his vyvanse...He took the lamictil last night before bed only 12.5 mg.

 

[totoro]

J- After we Difficult Child'd K from Lamictal a couple of months, she is an ultra-ultra-rapid Cycler.... we realized it actually WAS helping her! LOL She had just been through so many medications that we needed to get a clear picture of what was what. Know what I mean?
But know I do see that the Lamictal was a bit calming for her. She of course needed some other add on... she was at 200mg.
But I like knowing this, so when we do find the MS that works. If we need an add on, Lamictal could be the one.

I take it also, I am up to 100mg. I was on Topamax, that was destabilizing for me on high mg's, I have dropped back down, and titrated SLOWLY with the Lamictal, It seems to be doing pretty well so far! It has only been about 6 weeks of so. I am more up than down ever... a bit on the hypo and manic sides!!!
I have never gone a longer than a month without huge up's... so this has been pretty cool!!!
Good luck I hope something works

I was on Zoloft as well, I stopped that when I was starting Lamictal... things seem much better now. I will keep searching for myself if this peter's out!!!

 

[Nancy]

Lamictal has worked very well for difficult child too. Our psychiatrist explained that it is commonly called the peelaway drug among professionals because when it works like it was designed to you can begin peeling away the other drugs. We are in the process of peeling away strattera right now. difficult child has had no bad side effects and her mood is much more stable.

Nancy

 

[pepperidge]

jannie,

when my son was on a small dose of Prozac (after he flipped out on Lexapro) we found we had to keep upping the stimulant to deal with the disinhibition caused by Prozac. We ended up tripling the dose of stimulant.

We got a new psychiatrist who said he wasn't at all surprised with the medication reactions. He took him off the prozac ASAP. It sounds a bit as if the disinhibition needing more stimulant cycle imay be what is happening to your difficult child.

When we d/c the anti depressant and went to Lamictal we were able to go back to the 5 mg dose of Adderall that my son was on.

I would really urge you to discuss discontinuing the Lexapro and reduce the Vynase to a low level because too much can contribute to anxiety and then see what the Lamictal is doing.

By the way, 5 mg of Lexapro is not a really small dose. Check, but I think 10 mg is a starting adult dose.

P.

 

[Sara PA]

Ohhh, don't give Lamictal before bedtime. It can interfer with falling asleep. It may not happen to everyone but I heard that from both my son and my friend with epilepsy. They said it can keep them awake for about 3 hours after taking it. In fact, my son took his entire dose as soon as he woke up in the morning. He said it helped him shake off the sleepies.

Your description of a child who did well in the early grades but has problems as thngs become more complex sounds more like a child with learning disabilities than ADHD. A very bright child who has a learning disability of some sort is going to display a lot of anxiety when he starts having difficulty functioning because he's use to doing well and will be confused about why he can't excel as he once did.

 

[jannie]

I agree regarding the reduction of other medications. I'm glad many people have had positive results with Lamictil. Maybe I already said this, but now I'm just wondering if he's more manic than depressed...hoping that we chose the correct mood stabilizer to work with...but as others have said...he could be manic/disinhibited due to lexapro/vyvanse...

FWIW--husband is on 20 mg of Lexapro...and difficult child 1 is now on 10 mg...difficult child 1 seems to be responding well to the lexapro which is why we increased it...I sure hope I'm not messing him up by adding this to his mix !!

You all are the best !!

 

[Sara PA]

"Responding well" to an antidepressant is, unfortunately, often the triggering of hypomania. Hypomania looks and feels wonderful. It's a chemically induced mood swing and, as swings go, what goes up must come down. When the swing back occurs, the response is to up the drug that "worked so well". But with the long term use and on the higher dose, the hypomania comes back as full blown mania; the swing back becomes a total crash including anger, aggression and hostility.

Or not.

But that can happen. You have to be aware of it and you have to watch for it.

 

[jannie]

Ohhh, don't give Lamictal before bedtime. It can interfer with falling asleep.

Your description of a child who did well in the early grades but has problems as thngs become more complex sounds more like a child with learning disabilities than ADHD. A very bright child who has a learning disability of some sort is going to display a lot of anxiety when he starts having difficulty functioning because he's use to doing well and will be confused about why he can't excel as he once did.

I've always monitored the Learning Disability (LD) thing...but truthfully the adhd symptoms were always present, but just manageable. In kindergarten through first grade he mostly worked on self-control--raisng hand, working slowly, rereading info....

Once he started the vyvanse...even his music teacher noticed a great improvement in the way he played his clarinet. His handwriting improved...he was finally able to better answer questions in writing. He also was able to put to use all of the skills he had been taught over the past two years....Meaning when he finally started writing this year...his paragraphs were well written and supported...He still does struggle with writing but not nearly as bad...He also doesn't like novels because they are long and lengthy...yet can comprehend nonfiction ariticles quite well. I did support he over the years having him use predictable software programs such as co-writer and use the computer to assist with writing. He was working on keyboarding skills since grade 1. There are no easy answers !! Even if he has an Learning Disability (LD)...he still is emotionally stable..it's more than Learning Disability (LD)...but could be another co-morbid,

Heck--difficult child 1 has so many diagnosis....and now we are once again screening for Learning Disability (LD) !!!!

 

[Sara PA]

I've always monitored the Learning Disability (LD) thing...but truthfully the adhd symptoms were always present, but just manageable. In kindergarten through first grade he mostly worked on self-control--raisng hand, working slowly, rereading info....

Interesting comments. I was a product of the early childhood education system of the 50's. Your description of your son is what children were suppose to be in the 50's - lively, impulsive, racing from one thing to another. What we all were suppose to learn in kindergarten was how to go to school. It sounds like now days, most of us would be diagnosed as ADHD. We were just normal kids.

My undergraduate degree from the mid-70's is in education with a social science concentration. Though I am not a classroom teacher, I have the background. Nevertheless, the description of what schools are like these days still catches me off guard from time to time. I am absolutely convinced that the problem is more with the early childhood education system as exists today than with many of the brains of the children who are forced to survive in it.

I can't help thinking that we are drugging children to make them fit into an early childhood education model that demands inappropriately mature behavior and learning skills from very young children.

 

[smallworld]

I'll offer another perspective on what's going on. When my son was in day treatment earlier this year, his attending psychiatrist said some children with mood disorders present with anxiety early on, ADHD-like inattenion in the early elementary school years and then full-blown mood issues as adolescence begins. This is exactly the pattern my son followed.

My son also underwent 10 hours of neuropsychologist testing last year, and it was determined he has no LDs and no ADHD. He has a very high IQ, but has struggled with schoolwork more and more as he's gotten older, especially with written expression and ability to attend for long periods of time. But his neuropsychologist attributes all of his difficulties to mood issues.

by the way, handwriting (as well as other tasks) can definitely improve on stimulants, even if a child doesn't have ADHD. It happened to my son.

 

[susiestar]

Interesting thread.

My hope is that your children have been thoroughly and appropriately tested for learning disabilities like dyslexia, dyscalculia, dysgraphia and other problems. I know that having assistive technology has helped my oldest greatly. He simply CANNOT put thoughts on paper with a pencil. He can draw you a picture, but writing an essay with a pencil is torture. His brain simply doesn't work that way.

He had an alphasmart for several years, now the high school simply has him use the computer for ALL writing.

Dyscalculia is a math disability, it makes the numbers jump around, transpose themselves, and math can be extremely difficult. Use of a calculator SLOWED my son's understanding of math, though it sped up his calculations. He could get the right answer, but couldn't tell you WHY it was right!!

I think the medication question is hard for parents, ALL parents. Hopefully you will get the right combo soon.

Susie