I'm Confused

[Sickntired]

I don't understamd why this has happened but Through my difficult child's sneaky little self, things are better for once. On a daily basis I give him an ADHD medication of a morning and at night give him Zyprexa, now up to 7.5 mg. We have been trying to find the right combination for a few years. Always takes a stimulant of a morning and others at night. We have tried
abilify. Lamictil (gave him involuntary "chewing"), Invega, Geodon and now trying zyprexa. We have always had an underlying anger and agitation and opposition with any of these combinations. Last visit, difficult child asked about the patch for his ADHD (should have known the little bugger was up to something if he actually talked with the doctor!!!) So he gave us a free trial of the daytranna patch. I put them on him each morning while he is asleep and tell him to take it off around 4. Well, as soon as we started putting the patch on him, things behavior-wise got better each day. I was just elated. Well, I started noticing his appetite going way, way up. I know the zyprexa is notorious for weight gain so kind of wrote it off. well, come to find out that little dickens has been pulling his patch off after I put it on, not even wearing it an hour. BUT HIS AGITATION AND ANGER ARE CONTROLLED FINALLY. I can see him try to get angry, but it just doesn't develop. Not the instant anger like he had. What's going on here????

 

[DammitJanet]

It may be that the zyprexa is controlling his aggression.

 

[susiestar]

If they think he may have bipolar, or a mood disorder of any kind, the recommendation by the people who do the board certification of psychiatrists is to get the mood issue stabilized and then treat any ADHD or other illnesses.

Sounds like they started with a stimulant for the ADHD and then have been chasing around to stabilize moods and deal with aggression. Zyprexa is an atypical antipsychotic that is approved to treat mania in patients with bipolar. (from http://money.cnn.com/2000/03/17/companies/zyprexa/ ).

So if your little guy was dealing with MANIA (which can look a whole heck of a lot like ADHD!) and not ADHD, well, then the zyprexa is handling the mood and taming the aggression.

Have you read The Bipolar Child by Papalous? It is a pretty good book (can be tough to get through everything) but they advocate that any child with mania or a suspected mood disorder be treated FIRST as if they had bipolar (with mood stabilizers) adn THEN for any other problems. If mood stabilizers don't work, you have lost several months, but if stimulants can send people with bipolar into cycles that can take a very long time to stop.

There are arguments on both sides of the stimulant or mood stabilizer first argument. Antidepressants like prozac, effexor, zoloft, etc are also thought to send BiPolar (BP) patients into cycling. Some can tolerate antidepressants or stimulants AFTER they are fully stabilized, some cannot.

It can take 2 mood stabilizers, and maybe an atypical antipsychotic to help some patients be fully stable. That is a bunch of medications for anyone of any age or size. So it is good to "start low and go slow".

It will be interesting to hear what the doctor says on the next visit. I strongly recommend reading The Bipolar Child before the next meeting.

I hope things stay on the positive side as they are now.

Susie

 

[smallworld]

If your difficult child was worse on stimulant medications and he's now better without, I'm guessing the ADHD medications were making him anger and aggressive. He may not have ADHD and may not need stimulants at all.

I would recommend a full neuropsychological evaluation to make sure you know exactly what you're dealing with. Treating symptoms with the wrong medications can make everything worse for a very long time. I know because we've been there done that. My son's first diagnosis at age 9 was ADHD and anxiety. He got worse on the wrong medications (stimulants and antidepressants). After two years of struggling, he's doing amazingly well on a combo of medications that treat a mood disorder (two mood stabilizers and an atypical antipsychotic).

I hope you are able to figure out what is going on with your difficult child. Good luck.

 

[Sickntired]

Thanks for the help.
This is all starting to make sense to me now. His diagnosis from the psychiatrist is ADHD/ADD mixed type (I believe based on the school reports), mood disorder and ODD. Up until about 2 months ago, he was on a stimulant, Zoloft and an atypical antipsychotic, juggling the atypical around to different ones because his anger and agitation were not controlled. Finally stopped the Zoloft just before changing to Zyprexa.

Interestingly, he was re-evaluated by the psychologist for the school before an IEP meeting about 6 months ago, and the diagnosis from that school psychologist is: Bipolar and Learning disability not otherwise specified. He said he didn't think he had ADHD/ADD. I shared this with his psychiatrist, and he said he thinks about bipolar every time he sees him, but he still just does not believe that is what it is right now, may be leading to it, but not now. His psychiatrist is a certified child psychiatrist, so -------

All I have to go on is what I see in his behavior. He is definitely better without a stimulant and Zoloft,- maybe by not taking both of them, or maybe just not taking one of the two, I don't know, but he is better. Before stopping the zoloft and me completely stopping the stimulant, he had terrible insomnia. We would have to give him a medicine at night to sleep, and even with that, he could over-ride it sometimes. If he got "focused" on something, like something he wanted or trying to work on something(certainly not homework - lol) he would be up all night and crash around 5 in the morning. He simply couldn't turn it off. He's even stayed up the entire night, through the next day and still had trouble falling asleep that night!!! But now, he zonks right out. Don't get me wrong, his mood still is not where it should be, but the anger and agitation are not there like they were. He let's things go. It's like I tried to explain to his psychiatrist, it's like he's "stuck" in this mean, angry, agitated mood all the time. I don't see mood swings as I would define mood swings, just really horrible, agitated mood. Least thing would set him off.

I personally don't care what they call it, I just want him treated properly so he can return to the sweet young man I know is in there. If it's been this bad for myself and our family, I can only imagine what it must be like for him. Thanks again!