medication Changes

Discussion in 'General Parenting' started by Mandy, Sep 18, 2009.

  1. Mandy

    Mandy Parent In Training

    Little Bear was put on a new medication yesterday by his Dr. because he had a major rage at school Mon. that lasted for 30min and included hitting, kicking, biting, bad language. He had to be restrained of course and was suspended for 2 days.

    I talked to his Dr. and she believes he is definitly Bi-polar. Even though he has been doing great at home he is having these rages at school. It was decided to start 2ml of Celexa along with his other medications since we had never tried a SSRI before. She said it was a very low dose so might not have any effect but she wanted to try it.

    This drug is new to us so I had a few questions for all of you!;)

    I am wondering if anyone has used the combo of depakote, seroquel, and celexa before and how did it work for your difficult child?

    Did you have any negative side effects with Celexa?

    Did it help with anxiety issues??

    Thanks so much for reading!!!
  2. smallworld

    smallworld Moderator

    With all due respect to your psychiatrist, if he truly believes Little Bear has bipolar disorder, he would not be rxing Celexa. Celexa is an antidepressant that typically makes kids with bipolar disorder worse, not better. On the other hand, if your psychiatrist believes that the rages are caused by anxiety, Celexla might very well help.

    FWIW, my own kids have done very well on combos of a mood stabilizer (like Depakote), an atypical antipsychotic (like Serouqel) and an antidepressant (like Celexa).

    Good luck.
  3. gcvmom

    gcvmom Here we go again!

    My bipolar difficult child only takes Depakote and Seroquel. What smallworld says about an antidepressant affecting bipolar symptoms really can happen. In our case, difficult child 2 became MORE manic on an SSRI, but that was long before we knew he had bipolar and long before he was on the appropriate medications. All you can do is try and see how he responds, unfortunately.

    My older difficult child takes Celexa for anxiety. It seems just o.k. for him. I don't think it will end up being a long term fix though.
  4. Christy

    Christy New Member

    My difficult child has not tried celexa but did have a bad experience with an SSRI. Monitor this closely.

  5. rlsnights

    rlsnights New Member

    Hm...I too would be very cautious about adding an SSRI to handle rages. In my personal experience, rages are associated with

    1) Hypomanic or manic symptoms
    2) Mixed states (energy of mania plus despair of depression)
    3) STRESS

    It's pretty unusual for a kid to be doing well at home and having melt downs at school. As I understand it, what's more typical is for a kid to hold it together at school (due to social consequences with-peers) and to melt down at home. In which case I would be looking very closely at possible triggers in the school setting.

    If this hasn't been examined closely I would go there first before adding an SSRI, especially if he's in a regular classroom with no aide or significant interventions like chunks of time in an RSP setting or other very small group setting.

    In my experience, both with myself and with my son, medications can help but they are not a magic bullet. Many other factors like routines, triggers (sensory issues or too many changes too fast), stress (esp. in the form of expectations that are perceived as unreasonable or impossible to meet), criticism (or language that could be interpreted as critical) - these can make a vulnerable child lose it despite all the medications in the world.

    Identifying and then reducing or appropriately managing issues like these can be almost as important as getting the right medication combo in our experience. The medications help your child's brain calm down (for lack of a better analogy) but medications don't get rid of the basic tendency toward instability and don't eliminate things like poor sensory integration.

    Plus, if your child has been unstable for a while the pathways in his brain that lead to melt downs/rages are much more easily triggered than ones that help maintain his stability. That's why avoiding these episodes through environmental management is, in my humble opinion, one of the most important things you can do for your child right now.

    After a sustained period without big meltdowns, my son is much more able to handle stresses that previously would have led to volcanic eruptions. so I have put a very big priority on avoiding, directly or indirectly, triggers that I know are likely to lead to rages and actively managing a mini-melt down so as to avoid a major one. Figuring all this out has taken a couple years so don't get discouraged. Just stay focused on your goal and on the incremental improvements you see.

    Based on our experiences, your child is likely to benefit at least as much from a sustained period without rages (created through artful management of his schedule, environment and interactions with others) as from medication tweaks - once he has been on a mood stabilizer for a while and you have seen significant improvements overall.

    At the same time you are really pushing the school about changes there, if it were me, I would be wondering about the following medication tweaks before adding an SSRI (but I am not a psychiatrist and a lot depends on your child's presenting sx). These are pretty general ideas that may be completely wrong but may give you a starting place for a more in-depth conversation with your psychiatrist:

    1) change in mood stabilizer - has he tried Lithium? Or has the psychiatrist suggested adding a small dose of Lithium to the mix? I would suggest adding Lamictal but Lamictal and depakote don't mix well and it would be best to reduce or wean him from the depakote before adding Lamictal. Otherwise it has to be added very slowly.

    2) Has your child had his depakote levels checked recently? Also is he being closely monitored for liver toxicity and metabolic effects? If these things aren't happening, I would personally be looking for a new psychiatrist. These should be checked often, especially in a child so young.

    3) Try a different atypical anti-psychotic before adding an SSRI

    Finally, I would be also looking at supplementation of his diet with Omega-3s, Vit. D3, and Carnitine. You can have his Vit. D level checked if you want before supplementing this and I would definitely talk to his peds about how much Vit D3 (best form) to give him. Recent discoveries have shown that Vit. D works more like a hormone in our bodies than a vitamin and very low levels are associated with many different health problems.

    I suggest carnitine (an amino acid) because depakote strips this amino acid from the body. Some people are poor synthesizers of carnitine and, when on depakote, cannot maintain an adequate amount in their body without supplementation. My psychiatrist had me on this when I was on depakote. She said that it couldn't hurt (apparently there's no great danger of overdosing) and might help. Or you can feed him large amounts of red meat including liver.

    And there are actually some studies that show that Omega-3's have a positive effect on the stability of people with bipolar. Here's a link with more info on this.

    Again, this is something to discuss with psychiatrist and peds. The link above discusses possible risks/side effects and is a good place to start.

    Best wishes
    Last edited: Sep 18, 2009
  6. Mandy

    Mandy Parent In Training

    Thank you for all your great input!! I wanted to wait a week before I responded to see how Little Bear did. I did watch for any manic behavior due to your advice and I was a little worried for the first few days because I thought he was heading in that direction.

    Good News... It seemed to have worked:D I am so excited because we haven't had a rage in over a week!! That has NEVER happened since before starting medications or after our medication adventure. Also his ODD behaviors have disappeared and I can actually dicipline him when needed. Before we had a rough time even using the "basket" approach. He waged war over everything. He also is doing great at school even though I still cross my fingers everyday and pray for the best.

    I think Little Bear was on the depressive side looking back. It is so hard to tell with him being so young because instead of having classic depressive symptoms I had rages and ODD behavior. I am learning sooooo much this year!!

    I don't think I would have learned as much, this quickly without ALL of your help and support!! THANK YOU EVERYONE!!!
  7. Mandy

    Mandy Parent In Training

    :whiteflag: I think I understand the board jinx now!!

    I had to pick Little Bear up from school again yesterday. He had a meltdown early in the morning over a computer not working. Of course he is now AGAIN suspended for 2 days. The only good news is now the case conference is scheduled for next week. I put a call into his Dr. to see what her opinion is this time.

    I was so disappointed even though by now I should know better. Even though I know this is an ongoing illness, I still get my hopes up when things are going well. What a rollercoaster!
  8. gcvmom

    gcvmom Here we go again!

    Hopefully it's just a temporary setback, which is to be expected. The fact that he did have some really good days is encouraging.
  9. TPaul

    TPaul Idecor8

    My difficult child, Levi, also started medications this week and has shown a very dramatic improvement in his behavior. Truly like the tenderhearted, sweet, loving boy that was trapped inside had been able to come to the top and move about our house freely!!! I have been asking myself, can this be real!

    I know that things could changed at a moments notice and I am trying to keep myself prepared for that, however I am also making sure I make the most of each and every moment that I get to have with the current, maybe even temp side of difficult child.

    It has been a healing balm that sure has felt good, even if I get that for only a few days. Take every minute that you get of the calmer side of your child and allow it to feed that inner parent that thirst for a calm child. Take big gulps because tomorrow my find the watering hole bone dry.

    Have a good day
  10. 2much4me

    2much4me New Member

    I have been where you are, my difficult child was diagnosed at 4, and I had the constant battle with the school. Everytime there was a problem they would suspend him for 2 to 3 days, which to a 5 year old is a treat to have that extra time with mommy. Check the Americans With Disabilities Act, your child more than likely qualifies for modifications at school. My son qualifies which means that the school can not suspend him for actions that are related to his disability. My sons school is very cooperative and has provided him a "cooling down area" so that he can regroup and refocus after an episode without suspension.

    Notify the school of his medications, and when he sees the dr, the teachers can provide alot of insight as to triggers for episodes, and also if they are at specific times it can really help his dr. We have noted my son has his meltdowns at a certain time during the day, so now we are trying to adjust the medications since they seem to "lapse" at that time of day.

    Hope this helps!
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I have Mood Disorder Spectrum, the new name for Bipolar II. I've tried four SSRI's in my life and I can tell you a few things.

    1/The full effect doesn't kick in for six weeks at least. Anything earlier is just the body adjusting, good and bad. You are not seeing the real effects at this time. It's way too soon.

    2/An early good reaction can mean that the child will become manic on it. It's not supposed to "lift" you up right away. I was both told this and I experienced this too. I had one pill of Zoloft and felt so terrific I thought "This is IT!" Two weeks later I was in the hospital with mania and akathesia.

    SSRIs and all antidepressants are potentially very dangerous to those with bipolar. They can wait a good two months or longer before making the person "crazier" because they build up in the system slowly. Watch with extreme care. They can also cause suicidal ideation. My teen daughter pulled a knife on herself while on Prozac.

    Trivia so that you know in advance: Stimulants are also very risky for kids with bipolar and Straterra for ADHD is an antidepressant and a risk. Mood stabilizers with antipsychotics normally work the best. THey CAN cause cognitive dulling, but they shouldn't cause mania/raging. Mood stabilizers take a full EIGHT WEEKS to kick in. Any earlier effect is not usually the full effect or indicative of how the child or adult will do. However, sometimes you can tell in advance that it just is going to make things worse...then you use that very accurate MOM!

    I don't mean to scare you, but I do want you to be informed. Good luck.
    Last edited: Sep 29, 2009
  12. Mandy

    Mandy Parent In Training

    Thank you for all the responses! I love this board for it's great info and feedback:D

    I talked to Little Bears Dr. yesterday abt. the SSRI and she said we definitly need to be watching for signs of mania but that she has found with children that are violent, like my little man can be, that a low dose SSRI can help make the world a less hostile. He is on a VERY low dose we are increasing to 3ml today to see how that does (5ml is 10mg).

    The one thing I keep thinking of when my morale gets low is... we have come so far!! If I think back to Jan. before medications etc.... it was HORRIBLE!! We had rages everyday... violent one's, and life was very hard for the whole family. I know the school hasn't seen how much progress we made since they have only had him for 2 months so it get's frustrating. I "think" we are at least down to the tweaking stage of medications (i hope!).

    I am waiting to get the paperwork for the Case Conference nxt week any day now and I am anxious to see!
  13. tictoc

    tictoc New Member

    I'm glad you are having some success.:D It concerns me that the school keeps suspending Little Bear. Has there been any discussion of alternatives to suspension? Does the school understand what the issue is? Does he have a 504 or IEP?

    How does Little Bear feel about the suspensions?
  14. Mandy

    Mandy Parent In Training

    The case conf. next week is to start services for and IEP. Little Bear doesn't like suspensions at all and usually is angry that he can't go back to class. I am not sure he totally understands them, but alternative to suspension etc. will be discussed in the meeting nxt week.