lamictal update and question......

[Jena]

hi

so we're on day 5 of lamictal. i've noticed at bedtime the first night she passed out on half of 25mg i know really low dose. yet the rest of the nights it activated her. i have call into psychdoc for an appointment. yet i was wondering anyone else have this experience??

if so did it help with sleep at higher doses?? one of the things besides the hypomania we were looking to work on was the sleep issue which is a forever with difficult child.

also her Obsessive Compulsive Disorder (OCD) is pretty bad also, the cbt addresses alot of anxiety yet 1 appointment a week can't possibly address the compulsions she's seeming to have that i had no clue she had.

she is very verbal lately.... she said i have some more junk to share lol oh no!! she said if i look at something i have to stare for a certain time frame at it, if i turn my head right i gotta turn it left. if i do this i have to do it on this side also so it's even. she said i gotta be honest it's driving me insane lately. i've always though ti was totally nuts that i go thru this with almost everythign i do and i had to be honest and tell you i hope you dont' think i'm weird. there was alot more of the Obsessive Compulsive Disorder (OCD) stuff she explained, seemed to be whatever she did or does.

so i'm like hmmm what does one handle first or look to address first. whole reason we wanted to plant an ssri in her was because of the Obsessive Compulsive Disorder (OCD) that i didnt' know was that bad.

any thoughts, thanks

 

[pepperidge]

Jena

I have to say that in neither of my kids did we experience anything positive or negative at that low of a dose of lamictal. Given what you describe as her general behavior pattern that seems pretty dysregulated plus all the turmoil of your household, I would be reluctant to ascribe too much in the way of side effects to lamictal until you get up to higher doses. The only symptom it really addressed in my oldest (youngest didn't have much reaction to it at all) was depression and irritability. Topamax, on the other hand, did tend to make my youngest sleepy. I would venture to guess that lamictal may not be the drug of choice if you are trying to address hypomania and sleep issues, but who knows. In any event it is worth a try but I think you should be reluctant to conclude anything until you get up to about 200mg.

Have you ever tried an SRRI in a time frame where you could be sure that what you were seeing was the results of the SSRI and not just general up and downs of behavior?

 

[Shari]

This might be a dumb question but do you chart her on a calendar? Just a simple one that you can glance at that says on any given day "didn't sleep" or "slept well" or anything like that?

 

[Jena]

yes but i dont' need to shari, she never sleeps well unless on a new medication for the initial hit. this has been since birth. i have a sleep study appointment on may 6th for her than an overnight stay at hospital hooked up to machines. docs have always told me its' due to her bipolar. ahhh whatever lol.

pepper - easy child is gone and if that's turmoil than so be it. it's def. calmer here due to her being gone i wont' lie. i know it's a huge huge thing for difficult child to handle right now and that and easter threw her into mania i get that part of it.

im just frustrated to be hearing this experience of lamictal. doctor swore by it to keep moods even. i feel like sh'es a guinea pig. we'ev done so many medication trials and only one that ever worked for a period than stopped was seroquel.

as all docs tell me she's a complicated case. i'm sick of it already. so now she's on zyprexa nd growing by the minute in her gut and she's depressed more than ever due to gaining 60 pounds since portland. i get everyone with BiPolar (BP) deals wtih this yet she's only 12 trying to fit in and is huge right now. i keep trying to get her moving exercising yet nothing i do helps the mood or the weight that keeps on rising on a daily basis now.

again sick of it........ doctor said try lamictal to work on calming mood tahn we'll add in ssri for her compulsions and depression. now i'm hearing that's a bad choice. so aggrivated. 200mg dear god. she's at half of 25mg.

this is a joke i need a new pyschdoc yet no one's taking appointments. i play the medication game on my own with this moron. basically he's my i'l write your script guy.

pepper yes i'm sorry we have tried ssri's on multiple occassions her first medication ever tried will never put her thru that torture again. yet i was reassured that with the lamictal in place to keep her balanced non manic the ssri would do its' job.

 

[Steely]

I think it is way too low of a dose to really do anything. I would chalk her insomnia up to her still being basically unmedicated. Lamictal, from what I know, helps more with depression than the mania side, which is why, often, doctors use 2 mood stabs, one more for the mania, and one more for the depression. The Obsessive Compulsive Disorder (OCD) stuff is a whole other can of worms, but it seems if you can get her sleeping and regulated you will see less of the Obsessive Compulsive Disorder (OCD) stuff.

 

[Jena]

that's what i thought also....... yet my little difficult child is like an onion as of late........ you gotta peel back the layers.... to get to what's really going on. one thing i have noticed lately is she's alot more verbal about what's going on with her, what she's willing to take when with her dad pertaining to his own anxiety that's triggering her her grandparents etc. so she is growing up and maturing through this on one level. i just wnat to be able to help her and hit the right mix. i've been working on this since 7 it's time now dont' ya think?? LOL oh man i need a break!!!!

 

[pepperidge]

Jena,

I certainly think Lamictal is worth a try. But you have to be willing to invest two months or so into really trialing it unless you see consistently bad side effects. If you are going to do it, do it well so you know whether it is a go or not. Otherwise you are going to spend the next few years wondering if you should retry Lamictal.

And if it does help, it might in principle give her enough stablity to try an SSRI. But you are talking weeks I think before beginning a trial of an SSRI. Based on my experience, I would be really reluctant to add in an SSRI until you are sure you are at a therapeutic dose of Lamictal, which seems to begin around 200 mg and goes up from there. If you try an SSRI too soon and you see screwy stuff you won't know whether it is the Lamictal, whether the Lamictal wasn't high enough, or the SSRI.

Assuming she doesn't have true bipolar she may just have to wait until she gets older and maybe can tolerate an SSRI better.

What I don't understand is why you don't think about a different AP. Seroquel again, or even Risperdal, which might help with the anxiety but maybe will not lead to as significant a weight gain as you are seeing on Zyprexa.

 

[Shari]

I didn't really mean a chart for just sleep, just using sleep as an example.

For years, I kept a daily log of Wee. It was a regular size calendar, and I'd just note on it if he slept or not (he didn't sleep for years, either - as in, DID NOT SLEEP), if his day was "typical" (for him), calm (for him), or over the top (even for him - not talking compared to typicals here). I also noted his level of physical aggression typical, less, or more. And if there was some "extenuating circumstance" or something unusual that happened that day, I'd note that, too. But the point was, it was all brief. I printed my posts here and my emails to grandma and school, and kept those in a binder, so I could go and reference more info if I needed about what else was going on around any given time.

We hoped to see a pattern of behavior, and we did not, other than to confirm he is seasonal. However, he'd had a neuro appointment in Jan, and they did a depakote level check, and it was low, so we increased his Depakote to what should be a therapeutic level. A month or so later, he went all ape on us again...and I got to digging thru the chart. And because of the chart, we were able to go back and see that many of his really violent outbursts coincided with recent increases in his Depakote. And when I asked the doctor to check, she saw the pattern, also, and I learned that Depakote, when given in too high doses, can cause mania, aggression, etc. And what is considered therapeutic to most people, is too high for Wee. We cut back his dose, and I think he's still on less than half of what is considered "normal" for mood stabilization, but it works for him as much as anything has.


We also were able to use the chart to show docs, therapists, etc that we weren't screwing around. When i walked into juvie this winter with 4-3" binders and started throwing reports, evaluations, recommendations, and this kind of info at them, they realized real quick that they weren't dealing with a parent who wasn't involved. not that it will ever save my butt again, but it sure did that time. And when they said "try this medication" I could pull out the calendar and say "this is how he was on that one....not much different, huh?"

I really should be continuing it, but I've gotten a tad lazy. It will bite me in the butt, I'm sure.

 

[Jena]

hi

yes i did a chart on difficult child for years. thats' how i saw the cycles and patterns which lead to the diagnosis of bipolar once i had her with the same therapist for a prolonged period of time and the same pyschiatrist.

there was this flow or cycle to it. now medicated i don't see the swings anymore as far as up for so many days down for so many. it used to run unable to sleep monday thru thursday she'd be up till 3 yet school was also a factor here and anxiety than friday sat sunday she'd crash moods were different also.

i dont' chart it anymore because i'm trying to find ways of using my time time managment sort of. i did get extra tutoring hours for her i'm very happy so i just re did our entire schedule for now till end of june. she'll def. graduate now. tha'Tourette's Syndrome a great thing. with the extra tutors and them modifying workload we'll get there. she seems to be more focused wtih tutors and a bit calmer during day or maybe that's just in my head lol. she just dida two hour session with tutor and got a 100% on it. we haven't seen that in a long while.......

i don't want to add any ssri's till lamictal's in place. i'l just have to keep the zyperxa i'm too afraid to pull it. i don't know how to combat the weight tough other than having her run beside my truck lol. i feel bad all kidding aside she's really freaking out ove rit

 

[klmno]

Is there any chance she feels like it's her fault her big sis left- either directly or due to her health/MH issues?

 

[smallworld]

Lamictal can be activating, especially in the first week of each dose increase, but that typically subsides as the body adjusts to the medication. That's why psychiatrists generally recommend that it be given in the morning.

I agree that you won't know how your difficult child responds to Lamictal until you get her to a therapeutic dose of about 200 mg or so.

 

[smallworld]

I forgot to add that with Lamictal, kids often need another medication to help them sleep. My middle daughter A takes a small dose of Seroquel (50 mg) at bedtime to help her sleep. My younger daughter M takes Zyprexa and Remeron to help her sleep.

 

[Jena]

i'd like to bring seroquel back in yet what happens is as soon as difficult child adjusts to the dosage she's reved up again. i know it sounds crazy it's just how she goes. the 5mg of zyprexa isnt' doing anything for sleep now.

klmno yup your right she does blame herself for easy child leaving. i had a talk with her tonight about it, thanks for reminding me i had a quick talk with hera few weeks ago yet didnt' delve far enough. shes' hurting. i told her i wish i could fix this one for you but i can't. we just have to wish her well love her from a distance and hope she finds her way on her own.

 

[Junglelandmama]

Jena,

My difficult child is also difficult to medicate. Some medications do the opposite of what they are supposed to do and we end up with a big mess. She now has been on 75mg of Lamactil at bedtime and she is definetly ready for bed after taking that and Abilify. We do also give her Melatonin or Benadryl when/if she has sleep issues. She has been telling me that she feels like she is dreaming more on the Lamactil, more vivid and sometimes scary dreams. I will bring that up to psychiatrist next visit.

I am so not sure if there has been improvement in her moods, they are always awful this time of year, up down and all around. Of course, she is still not up to therapeutic level on the Lamactil yet.

This whole medication-go-round is frustrating and scary. I wish someone could come up with a better alternative, wishful thinking!

Hugs, Vickie

 

[Jena]

small remember difficult child flew on remeron?? seroquel wont' work for long on low dosage........ we have tried abilify yet it made her odd best word to use, naseous really wacked her out.

so, let me get this the lamictal is to keep the mood even....... not address anxiety so much...... more stabilization of mood. than another medications brought in to address other issues?? oh sheesh..... i've never done more than one this will take practice.

vicki hi how long did it take you guys to get to 75mg?? how much abilify do you use?? hang in there....... maybe it'll work the combo of the two together

she is severely activated..... cant' stay still at night..... so i've made our sleep problem worse it seems..... and zyprexa i now increased to 7mg. yet it isnt' helping.....

 

[Jena]

small i just bypassed one of your responses where you said give the medication in the a.m. stupid pyschdoc said give it at night. no wonder. now i gave her half of the 25mg tonight. i wanna start giving it to her in the a.m. i guess i can't put another half of 25mg in her in the am.?? that wouldn't be good.

i'd have to skip a day i guess and give it to her friday morning..... still waiting on dr. to call back and give me an appointment.

 

[pepperidge]

my son is up to 300 mg of lamictal. We give 200 in morning and 100 in evening--seems like there was some stomach issues. I would try the morning if you are not having great luck in the evening.

 

[smallworld]

I agree -- try Lamictal in the morning and Zyprexa in the evening (or split the Zyprexa dose morning and evening if that's what you've been doing).

 

[crazymama30]

Pepper and Small have good advice. My son is on 275mg of Lamictal. He takes his in the evening, but I am considering calling psychiatrist to see if we can switch times and try a morning dose as he has had problems sleeping lately. If you do not put in the time with Lamictal, you will not get an accurate trial.

fwiw, I remember seeing results with difficult child son at 50mg or so, but they would peter out after a few days.

 

[Jena]

i think i have to look back to why did i put her on lamictal to begin with?? she was up till 4 last night barely able to get up in time for tutor with me dragging her out of bed stressful.

this seems silly. zyprexa alone at 5 7 or 10 will not induce sleep. been there done that