Disturbing New Symptom

[Mandy]

A little backstory....Little Bear started having a relapse of his aggressive/violent behavior about 6 days ago which was a shock. We tried to raise his Seroquel then lowered it back down which was the only medication change we made. He was put on Celexa which really helped the aggression and we had one good month! We are now going back to the Dr. on Monday to try a new form of Tenex - Intuniv.

He saw the neurologist and had a normal EEG, she also put the papers through to try to get him in quicker to the children's hospital psychiatry dept.

Now to the disturbing symptom... I asked him last week why he was starting to get so angry again and his response after prompting him I wouldn't be mad by anything he tells me was

" There is a soldier in my head that wants me to do bad things. If I don't he will give me a headache"

Have any of you heard similar things from your Bi-polar children?? I am really scared now about Schizophrenia even though I don't think he meets the whole criteria. Please give me any advice you can!!! THANK YOU!

 

[gcvmom]

Psychosis happens with bipolar, too. I'm glad you are working to get him seen by a psychiatrist. I think a phone call is in order ASAP to relay this information to anyone who can speed up the process.

I don't recall why his Seroquel was lowered. Can you run us through that again?

 

[TerryJ2]

Oh, dear, I am so sorry.
But it sounds like a medication thing. I'm not basing that on any professional medication experience, just that he is on medications and you have been switching out the medications a bit. The only thing you can do I suppose, it put him in the hospital and do a medication wash, and then get the psychiatric to interview him about the "soldier" when he's not on medications.

I'm sure others here will have more ideas.

Hugs!!!

 

[Mandy]

The medication change was a vicious cycle it seems! We tried to raise the seroquel because he was still having issues, just not aggression. When we raised the Seroquel I saw some aggression come out and he had a violent outburst last week. I called his Dr. and she lowered back down to his original dose. The aggression was gone for 2 days so I thought all was well and then he started raging and has every day at least once a day since

He was suspended from school on Tues. because his rage was so bad he pulled hair, bit his aide etc. etc.

 

[gcvmom]

Was he on the Celexa before when you tried raising the Seroquel?

 

[DammitJanet]

medications wont cure everything and you can still have a few outbreaks of a behavior on a medication. If you just had one rage when you increased the seroquel but all else seemed to be better then I doubt that it was the seroquel causing the bad symptoms. Sometimes we all just blow up! I think it is more important that he had rages everyday when you lowered the seroquel back down.

I, too, am wondering about the celexa? How long on it? AD's can be bad for BiPolar (BP) people. Is he on a mood stabilizer? Have you tried one?

 

[smallworld]

SSRIs like Celexa can CAUSE hallucinations. My strong recommendation is to ask the prescribing doctor to wean your son from the Celexa and to keep him on only mood stabilizers and atypical antipsychotics.

We follow two rules that have stood us in good stead since 2005 when we started medications with our children:

Start low and go slow so you can see see what effect the change is having on your child.
Only make one medication change at a time so you know beyond a doubt whether it is helping or hurting.

My second recommendation is not to have knee-jerk reactions to medication changes in response to your son's behavior. Chart what is going on for a while and THEN make changes. Only in extreme cases have we discontinued medications abruptly (psychosis, extreme rage reactions, etc).

Hang in there and let us know how it goes.

 

[totoro]

I agree with what the others have said.
Hallucinations are something that need to be monitored very closely and not just assumed they are part of the disorder or caused by the medication.
Some kids have had them for years and just hid them very well, others are truly triggered by medications, which would not be a part of the BiPolar (BP).

My daughter had Hallucinations prior to medications and some medications have made them worse. When she is off of all medications they are still their, when she is on medications they are still there but sometimes not as frequent.
It isn't the end of the world all of the time and it doesn't always medication Schizophrenia, or Schizo-affective Disorder.
A lot of BiPolar (BP) kids do hallucinate, regardless or what Doctors will tell you.

Journal, keep track, we casually ask K each day how her voices/visions are each day. We tell her that it is not bad to talk to us and her doctor about it and that their is nothing wrong with what is going on in her head, (Only because this helps her talk about it) we tell her we need to know these things because sometimes medications can make it worse or cause it or help it... so we need to help the doctor and her and us understand all of this. SO then we can go from there and medicate properly, it is amazing how much our kids understand, she is only 8 and she fully gets it. She has understood it for years, she started talking about her "fairies" at 5 yo.

Once you know what kind of hallucinations they are then you can work from there.

 

[BusynMember]

If he never talked about hallucinations before, I'd be looking straight at the Celexa. I have taken almost every antidepressant known to man and many of them caused me to hallucinate. Usually it is NOT at first...for me it would take time before I'd hallucinate because it does take time to build up in the bloodstream. Then I'd end up in the hospital hallucinating and with toxic blood levels. I don't know if they can do blood levels for Celexa, but I'm betting it's that. Zoloft drove me into the hospital in two weeks. That's the least amount of time. Amitripytlene took a month on 150 mgs. and Imiprimine was good for six months before I woke up hallucinating and in the ER they took a blood level and...yup...it was way too high. After six months it had finally made me hallucinate.

You also need to be careful because at first I ignored the amitripytalene hallucinations thinking it was just my active imagination. When it finally hit me full force, I woke up unable to swallow (my throat was closing up) and not just hearing things, but seeing things and colors looked strange (it was like an LSD trip, they tell me). I had to drink water all the way to ER or I would have choked. These are serious medications and often I think we look at the disorder and not the medication, which can either be wonderful or, just as often, make things even worse. I'm on medications now that don't give me side effects. It takes time to find a good mix, and some people are medication sensitive.

At any rate, didn't mean to go off on a tangent, but want you to know that in my opinion it is probably the Celexa. Bipolar and antidepressants are often not good friends. And, sadly, doctors, instead of saying "Let's lower the dose" are more apt to say "Let's increase it." Have learned to tell the doctors, "Um, no, let's NOT increase it. I'm weaning down first to see if I feel better, then, if I don't, we can increase."

Just passing along my experience. I have a serious mood disorder and was a difficult child myself

Good luck, whatever you decide to do.

 

[Mandy]

Thank you for all your responses! They really helped ease my mind about this new symptom.

We are going back to his Dr. on Monday and over the phone talking with her I think we are going to stop the Celexa anyway so hopefully this helps!

My second recommendation is not to have knee-jerk reactions to medication changes in response to your son's behavior. Chart what is going on for a while and THEN make changes. Only in extreme cases have we discontinued medications abruptly (psychosis, extreme rage reactions, etc).

One thing I have learned after going through so many medications is to know when a dose is not working well for Little Bear. Many times before I waited and waited before calling the Dr. when I knew something was going bad with a medication. I think this caused un-needed suffering for both me and Little Bear so now I call right away when i get that gut feeling that something isn't right!!

When we raised the seroquel it was more than one rage. I usually wait until I see several in a day or several days in a row or a really violent one. I have learned to become very in tune with Little Bear and his ever changing moods and I do journal everyday with his medication schedule, any rages, etc.

He has still been raging and had a rough day at school again Friday. Right now because of his aggression he is only going to school for about 2 1/2 hours a day

Thanks again for all the responses and good advice!!

 

[smallworld]

The raging could be from the Celexa-induced hallucinations, not from the Seroquel. Just a thought.

 

[Mandy]

smallworld~ Thanks for that info! He has been on the Seroquel for quite some time now so the Celexa might very well be the culprit. He was only put on it a couple of months ago to help with aggression which did work for awhile.

We are going to his Dr. appointment in a couple of hours to talk about the Intuniv(new Tenex) and he will probably be coming off the Celexa. I am not sure what else?? The neurologist we went to last week said it was a good choice to try while we are waiting to get into the Children's hospital!

 

[smallworld]

Just a suggestion: Only make one medication change at a time. Is he currently on Tenex? I have read of kids having aggression and hyperactivity problems when they have switched from Tenex to Intuniv. Furthermore, kids can have flu-like symtpoms (headache, nausea, dizziness, stomache ache, etc) when they wean from SSRIs like Celexa. So you want to make certain you know what is what when you are switching around medications.

 

[Mandy]

Back from our long appointment!

Little Bear has never been on Tenex so the Intuniv is new for us. He will be starting at 1mg dose which is the starting dose for 7 days and then it is slowly increased. We are weaning him off the Celexa starting tomorrow slowly and then it will be a watch and wait approach over Christmas break.

We talked a lot about him having comorbid conditions such as being on the Autism Spectrum along with having Bi-polar disorder. We really aren't going to have this piece of the puzzle until we get our appointment. with the children's hospital though. That's all I want for Christmas!!!

Thanks again for all the help and advice!!