How do you handle the raging appetite?

[Alisonlg]

Oh my gosh- if he keeps this up, my beanpole 8 yr old is going to be a blimp in the next few months! The minimal dose of Zyprexa he's on is making him insatiably hungry and he just keeps going and going and going and going.

I know this is normal on these types of medications and that a lot of you have dealt with this side effect, so I was just wondering if you've found a way to cope with it and help your child manage the hunger so they don't blow up.

He's a picky eater, so as far as changing the types of foods he's eating, I've done the best I can as far as going high fiber and offering healthy choices (high fiber cereal with low fat milk, yogurts, etc.). I've also tried the trick of offering him a glass of water or milk BEFORE he eats to try to fill him up, but he refuses.

Anything else?

 

[oceans]

Zyprexa is the worst for weight gain I was told. That is why after the school year is done, we are going to try to switch him do a different AP. Maybe Geodon. The psychiatrist at the psychiatric hospital was thinking a abilify. So, if he starts gaining too much weight, you might want to ask about switching to one that might not be so bad with weight.

My son never feels full on the Zyprexa and that is the major problem. He tries to eat healthy choices and we are going to the gym a few times each week for exercise. I am still working on getting him to limit his portion sizes which is his big fallback.

I'm afraid all you can do it to try and give him healthy foods and good portion sizes and keep him active. If he gains too much weight think about a different AP perhaps.

Is it helping him? Sometimes you need to weigh out the benefits vs. the side effects.

 

[Alisonlg]

Is it helping? That's the million dollar question! LOL He's only been home just over a week and had only 3 FULL days of school. We've had a lot of oppositionality, a lot of hyperactivity (especially when he first came home), and 2 big meltdowns (one that included him smashing his head with the metal bottom of the shade repeatedly in his room and punching me in the arms). So, is the medication working? You tell me. I suppose it could be worse, but without consulting a psychiatrist I feel pretty lost in this whole process.

He's currently attending a day program now at the hospital that he was admitted to and the same Dr he saw at the psychiatric hospital oversee's the program, so I assume she'll be the one following his medications there too, but I feel so out of the loop.

Aside from the help he's getting at the day hospital and the minimal dosage medication he's on, I feel like we're still in the same place we were almost a month ago prior to his psychiatric hospital admit. ::::

 

[smallworld]

How much Zyprexa is he taking?

 

[Alisonlg]

1.25 mg twice a day

 

[oceans]

Can you talk to the psychiatrist at the hosptal program and tell him what is happening at home? Perhaps he is not on a therapeutic dose. Mine started at 5 mg and he is doing well on the 5, but the psychiatrist at the state hospital was saying that they usually go up to 10 mg. You might want to just check it out with the psychiatrist to be certain that he thinks he is on enough dosage given how he is acting, or if they have any other thoughts about medication, therapy, or programs .

 

[Wiped Out]

ALisong,
I hear you about the raging appetite. When my difficult child is on medications that affects his appetite we've been able to do very little to stop him. Right now it seems he is eating non-stop. He's always been a very small boy but not so much anymore. I wish I had some advice but wanted to let you know you are not alone. Hugs.

 

[smallworld]

Alison, with any medication, there are side effects, and it's important to weigh the risks against the benefits. Atypical antipsychotics like Zyprexa cause weight gain as one side effect. My easy child has gone from 31 pounds to 48 pounds while on Zyprexa since July. Since she was very underweight to start with, some of the weight gain was welcome. Now that she has been on the medication for many months (and we dropped her dose down a little once her anxiety improved), her weight is fairly stable. So there is a chance your son's weight will plateau once he's been on the medication for a while.

My easy child saw some benefit from 5 mg Zyprexa, but when she was increased to 7.5 mg, she really began to eat almost normally (she was put on medications last summer because she developed a choking phobia that led to complete food refusal). I'd hazard a guess that your difficult child's dose is too low to make much of a difference. You really need to tell the prescribing psychiatrist what you're observing and ask what can be done medication-wise.

One final thought: Are you satisfied with the ODD diagnosis? There are no medications specifically for ODD so I'm wondering why the Zyprexa. Is the day hospital program any closer to a true diagnosis? It would be helpful to know exactly what disorder you're medicating. If you knew, you would be able to medicate the disorder properly.

 

[Alisonlg]

Am I satisfied with the ODD diagnosis? No...I'm not. We had started to seek a re-evaluation to look for co-morbidities and the week of his first appointment with the SW who was starting his evaluation was when he had a major series of meltdowns at home and school and was admitted to the psychiatric hospital. I thought for SURE he'd come out of there with a solid diagnosis, and instead, he came out with a more fuzzy one..."Disruptive Behavior Disorder- not otherwise specified" with the CD and ADHD basically ruled out, which basically leaves the ODD.

They rx'd the Zyprexa (after trying Risperdal with intollerable side effects) to "lengthen his fuse" so he would hopefully remain more calm and not blow up as easily when he gets frustrated or angry.

I've mentioned some things to the psychiatrist about difficult child that they didn't see at the psychiatric hospital...like his rapid mood swings coming out of a rage (bouncing off the walls, talking fast and inappropriately loud, big ideas, super happy as if nothing has happened- basically manic) and she told me it was definately something to watch, but without a family history of anything like bipolar and with him being so young, she wasn't about to really look any further into that.

 

[smallworld]

Alison, in your shoes, I'd look for a second opinion with a child psychiatrist who has experience treating kids with a variety of mood issues (including early-onset bipolar disorder). I'd also find a neuropsychologist to do some cognitive and psychological testing on your difficult child. We've had evaluations with both types of professionals (except for easy child, who has not seen a neuropsychologist -- yet!), and it's the only way we've been able to make any progress. We don't have bipolar disorder in our family tree either, but we have lots of anxiety and depression. difficult child 1 truly could have bipolar -- he's being medicated as if he does and he's improving -- but honestly, we're not going to know for sure until he's a little older. At the very least, his psychiatrist is considering the diagnosis and treating him as such. I personally think you need more info on your difficult child before a medication path is chosen.

 

[Alisonlg]

Well, I definately want a neuropsychologist exam done and I definately want someone to look deeper and hopefully get a more thorough diagnosis here, but he's still currently immursed in the Day Hospital program and will continue to be until probably the end of May.

I don't think this psychiatrist working with the psychiatric hospital/Day hospital has any true intention of working out a diagnosis and she already shot down my request to get a neuropsychologist involved...her basic goal is to get and keep him stable. As long as the medication lengthens his fuse enough to keep him and us safe and the coping skills they teach at the hospital are effective enough, then they've done their job I guess.

Is that how it usually works?

So, once we get done with THAT, then I guess we'll start working more individualized with another psychiatrist who maybe I'll actually have a phone number for and everything!!!! LOL

 

[pepperidge]

I don't see why at least you couldn't have a neuropsychologist evaluation done. I would think that would rule in or out any underlying disabilities that could cause frustration etc at school. Or perhaps any autistic spectrum type issues, though that doesn't sound like the case here.

I dunno, if a kid his age spent two weeks in a psychiatric hospital and is now in a day treatment program, I would definitely think that a mood disorder could be present. And unless the Zyprexa turned him around pretty darned fast, I think I would want to ask the psychiatrist about getting a second opinion from a psychiatrist that specializes in mood disorders. Again, the actual diagnosis is less important than getting on the right combo of medications. You've tried Risperdal, now Zyprexa, I would think if those don't work your next bet would be to go fairly quickly to a mood stabilizer.

I think one of the most difficult things to do is to manage to find a psychiatrist that you trust and can work with. good luck.

Do you like what you see in terms of the progress he is making in the hospital program?

 

[oceans]

We don't really have a diagnoses either. We have the MDD diagnoses, and the possible ADD diagnoses (which was his first diagnoses). There is more going on then that, but they will not diagnose until more symptoms present themselves. The difference is, that with us they are treating the symptoms and the medication is working. They also agreed to add the Lamictal after 3 yrs of medications not working and me continually asking them to try it for 1 1/2 yrs. From what you are describing, the dosage of Zyprexa they have him on does not seem to be doing the job. It is not enough to keep him stable. I would want to talk to the psychiatrist about that fact. It could be that he is on too low a dose, or that Zyprexa alone is not going to be enough. He might, in fact, need a mood stabilizer in place. I hope that you can talk to this psychiatrist about what you are seeing at home...that he is not stable yet. I am glad to hear that you have a number of a new psychiatrist to work closer with. It is a long road to travel in finding the right medication combination. Good luck!

 

[guest3]

um we just finished installing locks on our fridge and pantry, I kid you not, that is how obssesive compulsive my difficult child II is about snacking and difficult child I is a teenager so he is also always gnoshing, not anymore. There's a coleman cooler of unsweetened tea on the counter and meals and snacks will be rationed out on a daily basis. This mom is through with the super sized grocery budget.

 

[guest3]

PS it's helping my waistline as well, it's too much of a pain to unlock everything to grab a snack, and they also hear the keys jingle, LOL!