difficult child up all night...At my wits end

Discussion in 'General Parenting' started by tictoc, May 25, 2010.

  1. tictoc

    tictoc New Member

    difficult child has been transitioning from Trileptal to Depakote ER since our psychiatrist visit two weeks ago. He has now finished Trileptal and is taking 500 mg of Depakote ER. We made this switch after several very good months on Trileptal because difficult child once again became hypomanic a few weeks ago. psychiatrist had difficult child take Klonopin for three days to bring him down (which worked) and started the transition from Trileptal to Depakote ER at that point.

    We went from 250 mg of Depakote ER to 500 mg on Thursday. difficult child was up most of the night vomitting after the increase, so we kept him home from school on Friday. The Depakote hasn't made him nauseas since.

    Fast forward to last night: difficult child woke up around midnight and has been up since then (It is now 10:30 a.m.). He has slept a total of 2 hours in the last 28 hours. He shows no signs of fatigue, but I kept him home from school because I'm sure he will crash at some point. He doesn't have the bright eyed hypomanic look he had a few weeks ago and he isn't talking non-stop, but--clearly--this isn't right.

    He is manageable...Not violent, not even paticularly irritable. Just very AWAKE and GLEEFUL. Right now he is watching PBS Kids and picking at his feet (which he used to do to the point of bleeding, but had quit doing since he started imipramine). He is showing some exaggerated glee at minor things (DRAGON TALES!!! YAY! DRAGON TALES IS ON!!!).

    Not sure what to do. husband is in one of his, "I dunno...He gets like this," stages. Have I mentioned that the D in husband is for DENIAL? Anyway, husband would freak out if I call the psychiatrist and come back with the recommendation to give him Klonopin again (Klonopin did bring difficult child down, but also made him a little disinhibited in other ways...and very lethargic). This morning I couldn't even get husband to talk to me about what to do. I always try to get husband on board before taking action, but--frankly--I'm getting tired of it.

    I know that the Depakote hasn't had time to do its thing, so what do we do now?
  2. smallworld

    smallworld Moderator

    Sometimes atypical antipsychotics (Risperdal, Seroquel, Zyprexa, Abilify, Geodon) are used in conjunction with mood stabilizers to help with hypomania or mania, especially as one is transitioning from one MS to another. APs help with sleep and to tamp down on manic tendencies.

    It does take 6 to 8 weeks at a therapeutic level for Depakote to take effect so maybe you should ask the psychiatrist about an AP. Seroquel is particularly good for sleep and anxiety.
  3. smallworld

    smallworld Moderator

    by the way, how high did your difficult child go on Trileptal? Why didn't the psychiatrist just raise Trileptal instead of just discontinuing it?
  4. tictoc

    tictoc New Member

    Thanks, smallworld. difficult child was up to 1200 mg of Trileptal. We continued to go up on Trileptal after we started seeing a lot of irritability in difficult child, but before the hypomania. The increase didn't seem to help with that, so the psychiatrist thought it was time to move on.

    As for APs...I am all for it (and so is psychiatrist), but husband refuses to let difficult child take an AP. husband thinks the risk of tardive dyskenisia is too high. psychiatrist and I have both argued that what difficult child is actually experiencing NOW is worse than the risks an AP poses for the future. But, this argument isn't working with husband. I am so tired of constantly being at odds with him over how to best treat difficult child. Thank goodness I have my own therapy appointment on Thursday.
  5. smallworld

    smallworld Moderator

    APs have a bad side effect profile, no doubt about it, but sometimes they can be used in the short term. TD is generally a long-term side effect. My husband is like your husband -- he didn't want to use them -- but we got to the point where we had to because we ran out of other choices (my kids don't do well on SSRIs). APs target certain symptoms that other medications don't. What we found is that we could use APs for a while and then wean down to a lower dose once the crisis passed.

    We moms certainly need our therapy appointments -- can't live without them!;)
  6. gcvmom

    gcvmom Here we go again!

    We've had really good support from the combination of Seroquel XR AND Depakote ER for my difficult child 2. He cannot function on a mood stabilizer alone. Just doesn't cut it.

    As far as side effects go, we initially had a LOT of sedation at the lower doses of Seroquel. It also increased his appetite. But once we got up to a higher dose, things settled down. He's still a bit sedated about an hour or so after he takes it, but he functions o.k. Doesn't fall asleep in his seat like he did initially. And his appetite is normal now. He actually had a dystonic reaction to the OTHER atypical antipsychotics. Seroquel's profile is a little bit different, and my understanding is the risks for the movement disorders are lower.

    Good luck to you!
  7. shellyd67

    shellyd67 Active Member

    Hi Tic Toc,

    I am responded to your post for two reasons ... first off, have you tried melatonin for your son? From what I have read from other posts and forums it works quite well and considered to be a natural sleep remedy.... You can purchase it OTC at any Walgreen's, CVS etc.... Second, I am unable to give you specific advice about melatonin because my husband will not allow difficult child to take it ... I have explained that I spoke with psychiatrist and very experienced pharmacist he still refuses to allow difficult child to try it because he feels as though 1 more medication will send difficult child over the edge. He is only taking 36mgs of Concerta and is up until atleast 11pm every evening. I keep pushing but will not give it to difficult child if husband is not on board .... I can relate to the frustration. I hope your difficult child gets some rest soon ! Good Luck ! :faint:
  8. tictoc

    tictoc New Member

    Thanks for your replies. I hadn't thought about the possibility of an AP for the crisis period and then weaning down. That possibility might go over better with husband.

    It is now almost 5 p.m. and difficult child is still going. He is starting to seem tired and is less gleeful, but still...

    Re melatonin: difficult child takes 3 mg an hour or so before bedtime every night. It usually does seem to help. I sympathize with being up with your difficult child until 11:00 every night. difficult child used to be up until 10 or 11 every night, but the combination of clonidine and melatonin usually means that he is asleep by 9:00.

    I'm thinking a call to the psychiatrist is in order. We have an appointment that is more than two weeks away and I think that is too long. husband and I have talked several times today and he seems to be coming around to the idea that something is off. We'll talk more tonight, assuming that difficult child actually sleeps.
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I'm surprised nobody picked out the imiprimine as the reason for hyper-mania. Has he been on it long or increased it? I took imiprimine and it worked well for six months (I may have been a tad hypomanic, but I liked it). Then one night I started hallucinating and had to go to ER and my imiprimine level was in the toxic range. Imiprimine is funny that way...it can build up like that.

    My own son had terrible side effects to Risperdal and Zyprexa...awful, horrible, scary ones. But he did ok side effects wise on Seroquel. I think that may be more mild. Maybe hub will let him try that. I understand your hub's fear. My son and I have been on tons of medications and I can tell you that sometimes the side effects are worse than the problem. It's very hit and miss. I totally think you should try Melatonin or Benadryl (an allergy medication) for sleep while the new medications kick in. Both worked for my son, short-term.

    I wish you good luck. And I'd look at the imiprimine. I have a mood disorder and have been on so many medications I don't know if I can remember them all. My son was misdiagnosed with bipolar and he was on a slew of medications too. We've had our share of experience.
    Last edited: May 25, 2010
  10. tictoc

    tictoc New Member

    MWM, I'll check with the psychiatrist about the imipramine. difficult child takes a tiny dose to help with his Obsessive Compulsive Disorder (OCD) and it has been very effective. He has been taking it for 9 months. We haven't changed the dose at all since the first month or so. But, I'll ask the psychiatrist about it. Thanks.
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    tictoc, although most people don't know this, the doctor can draw an imiprimine level so you can actually find out if your son is at a good level or if, like me, he metabolizes it in a weird way. The doctor may poo-poo the idea, but I'd push for it. When I went to ER, the doctor said, "Oh, you can't possibly be toxic on such a low dose." (I forget what my does was. Maybe 50 mgs? but he took a lab level and surprise!!! the level WAS int he toxic range and he was shocked. So that's one option you can pursue. And again this was after six good months on a pretty low dose. Some kids are sensitive to medication...as well as some adults too! :tongue: Good luck!
  12. tictoc

    tictoc New Member

    Thanks, MWM. I'm going to ask the psychiatrist to order a test. difficult child takes 6 mg of imipramine a day, but it had a huge impact on his behavior, so maybe it isn't so low for him. And, in the past he has had extreme reactions to very low doses of other medications (i.e. Zoloft).

    I have a call into the psychiatrist. difficult child finally slept last night, but he has been nauseas and vomitting off and on since last evening. Not sure if it is a reaction to the Depakote, stomach bug, or who knows what. But, he is miserable today.