Keeps regressing

Discussion in 'General Parenting' started by samn2, Jan 20, 2017.

  1. samn2

    samn2 New Member

    DS12's depression keeps getting worse. We tried Zoloft and then Celexa after a Zoloft fail. With both the Zoloft and Celexa we saw huge improvements and then major backslides. We then ruled out SSRIs and tried Lamictal. As we were titrating up there was almost a switch overnight at 150 and I felt like I had my son back. Less than a week later he completely regressed. We titrated to 200 and the results were amazing. Fast forward three weeks and now we are back to where we started. I have a call into his P-doctor to see if we increase Lamictal or try something else? At one point he had mentioned Abilify as a future something to consider.
    I just received an email from school and he melted down and started hitting himself then when brought to the hall was banging his head on a locker as punishment to himself since he is "so stupid." I've caught him with a knife before and we are one step away from him engaging in cutting which he has expressed interest in before. I hate that he is going through this and I know there is no magic pill but any advice or experience you can share would be great. Thanks!
  2. ForeverSpring

    ForeverSpring Well-Known Member

    Has he been evaluated intensively at a university hospital or a Neuro psychologist? Are you relying just on pedatrician or a talk therapist?
  3. Crayola13

    Crayola13 Active Member

    It might be a deeper problem than depression. Did his doctor rule out bipolar disorder? Ask the doctor if he is having bipolar cycling or if the mood changes are a response to the medication changes. What type of doctor prescribed the medication?
  4. ForeverSpring

    ForeverSpring Well-Known Member

    Is he in therapy with a good psychologist? Pills alone won't help. Also the hitting himself in the head reminds me of autism, high functioning.

    Whatever...he needs a very intensive evaluation, not just a prescription. And he needs a professional who knows how to do testing for all disorders. My son had ten hours of testing and we also had to fill out forms. A pain, but we got answers and he is now really doing well.

    I love Neuro psychological testing. This is not a neurologist. It is a psycologist with additional training in the brain. You can find them in university and children's clinics. I can not express in words how thorough my son's doctor was. He worked at Mayo Clinic once and had a long waiting list. The good ones do, but they are worth it.

    Good luck!
  5. Praecepta

    Praecepta Active Member

    I'm thinking bipolar as well.
  6. susiestar

    susiestar Roll With It

    I agree that you need a more in depth evaluation. I hope you have a psychiatrist, one who is board certified at working with children and adolescents, treating your son. I also hope you get an appointment with a neuropsychologist as soon as possible. Until you get an appointment with a neuropsychologist and get the testing done, please ask your psychiatrist to do the dna testing to see which antidepressant would be most effective. If you have not done this testing, it is trial and error to find the right medications. The dna testing will take a lot of that guess work out and point to which family of medications is likely to work best. IF this is just depression, then it will likely be medications in this family that work. You only tried two of the antidepressants and that is a FAR FAR FAR cry from all of the antidepressants out there. My son has major depressive disorder that is intractible, meaning super hard to treat. We had MANY docs who wanted to call him bipolar but he isn't. He just needed more than one type of antidepressant on board. The right kinds of antidepressants have made a HUGE difference and he has been on the same ones for years now - he likes how he feels on them and that he can work through the times he is down.

    If they think he is bipolar, he needs to be given the entire bipolar regimen, which starts with a mood stabilizer. An atypical antipsychotic is often added to this and can be very effective. Until his moods are stable, antidepressants should NOT be used as they can cause mania. IF depression still lingers once moods are deemed stable, very small doses of antidepressants are sometimes tried, but this is done very very carefully because it can cause mania and mood swings. Stimulants for adhd are also not given until moods are stable because they can cause mood swings. If they must be tried, they are tried in very low doses because they can cause mania and mood swings. Even cold medicine can cause mania if you have bipolar. I urge you to read The Bipolar Child if your son is given this diagnosis. It includes the medication regimen - many MANY doctors will not follow this regimen because it is a lot of work for them. PUsh the docs to follow this because it IS the best regimen to follow if your son is bipolar.
  7. samn2

    samn2 New Member

    Thank you for all of the responses. To answer some questions:

    We moved to this area last April so we are dealing with a brand new set of doctors.

    He did do full neuropsychologist testing July 2015. (Loads of questionnaires and hours/days of testing). Results were ADHD, ODD, Anxiety and Depression. Around then he was also diagnosed with precocious puberty. ODD symptoms seemed to have mostly disappeared with his testosterone levels now decreased. Aspergers has been mentioned by several therapists but at both the neuropsychologist testing and previous testing done by a child psychiatric it's never been diagnosed.

    He is being treated by a Psychiatrist for medications. The psychiatric mostly sees adolescents but isn't a pediatrician psychiatric. Our insurance only pays for one group of child psychs in the entire metro area and they haven't been accepting new patients for over a year. The current psychiatrist did come highly recommended and it took me a long time to find him.

    He does see a child psychologist for therapy weekly.
    Last edited: Jan 21, 2017
  8. susiestar

    susiestar Roll With It

    MANY psychiatrists miss autism spectrum disorders/aspergers. Even after my son was diagnosed and we could see how PERFECTLY the diagnosis fit him, every time we saw a new psychiatrist due to insurance or whatever, the new psychiatrist wanted to start with all new diagnosis even if things were going very well. It was like they wanted to reinvent the wheel each time and it drove me crazy.

    For an accurate autism or aspergers (they changed the names a couple of years ago, but I haven't had a reason to keep up, sorry), a developmental pediatrician or autism specialist would be your best bet. A psychiatrist is NOT the best to diagnose autism, in my opinion. They just don't have the training in it.

    Push the psychiatrist for the DNA test. It really is the most reliable way to find out what medications are the best way to handle his depression. Even though you had bad luck with a couple of SSRI/SNRI antidepressants, that is such a small sample of that type of antidepressant that you have barely scratched the surface. The test will tell you which type is most likely to work for him. Insurance usually pays for it and it IS a reliable test. A few docs still tell patients that it isn't, but that is just backwards thinking.

    Your son could be like mine. My son really struggled for years. It wasn't until he was on an SSRI antidepressant, on strattera for his adhd (which is also an antidepressant that just happens to work on adhd better than as a primary antidepressant) and then he was put on trazodone for sleep that it all fell into place. For some reason insomnia runs in my family very bad. My grandmother slept maybe 4 hours a night. I do the same without medications and so does my father. Sadly my son got this same thing. You need sleep to function well. Trazodone is an older tricyclic antidepressant that pretty much sedates you. It takes all 3 of these medications working together to handle his depression. It may take something similar for your son. The DNA test will take away a LONG period of trial and error, and MANY awful side effects from medications that don't work for your son. Please insist that the doctor do the test. It truly is THAT helpful and important.
  9. JRC

    JRC Active Member

    Hi Samn2-

    My son is about your son's age (he is 11) and he is also on Lamictal. He's been titrating up for the last year (as of Feb 3 of 2016) when he was diagnosed with bipolar disorder. He's experienced the same plateaus as your son, I think, where he reaches a certain level of medication in the blood stream and is better, only to start the depression/hypomania cycling again after a few weeks. We switched doctors this past fall to a well known psychiatrist/researcher in the Boston area. She has him on 250mg of Lamictal at present, plus 15mg of Abilify. He was taking resperidol but we've weened him off (because of the switch to abilify). The abilify helps with depression as well as working as an antipsychotic, from what I understand.

    Right now my son is sort of stable. Good days and bad days. Mostly depression with the occasional hypomania thrown in just to keep us on our toes. My husband and I are at our wits end, however, because he has missed so many days of school, and when he is there, he only stays till 11am (he's in 5th grade). My son said to me today that he is worried that he will be held back (they won't) and he's worried about going to middle school next year (he should be). I'm starting to look at alternative schools for him now because I just don't see him being able to handle regular public school in the future. It's depressing and makes my husband and I feel hopeless.

    I'll be very curious to see what your doctor thinks should be the next step for your son's medications. I'll keep you posted about our son's next steps as well.