medications question


Active Member
if medications are changed and started on a low dose that is supposed to be added to with time, how do you know if the medication is working? when should you say "we need to stop this one-it's not doing anything" instead of "he's not getting enough yet- increase the dosage"? it seems to me we could spend months on a medication, increasing it and adding to it, before determining he shouldn't have been on it in the first place.


Active Member
You have to research the medication, and be very aware of your child. I keep a difficult child note book, in which I just jot down he has been that day. I do not even do it every day, though I try. We are currently titrating up on Lamictal, and I can see a difference. My son is much younger, he is only 9. It is not easy.


If you're talking about mood stabilizers, they can take weeks, even a few months, to take effect. With Lamictal, you are probably looking at a range of 150 mg to 200 mg to reach a therapeutic dose, and you have to titrate slowly to avoid the side effect of a deadly rash.

What dose is your son on? What behaviors are you seeing that concern you?


Active Member
Thanks, guys! He was put on prozac last year and I was reluctant at the time to agree because he was in psychiatric hospital and many changes were taking place at home and school so i knew if medications came in the picture, there would be no way to know for sure what really helped or didn't. as it turns out, i think it probably did help. then, this winter/spring we go thru similar problams and difficult child gets in big trouble and doctor says maybe problem was caused by increase in prozac. (try telling that to the judge)So, he switches him to a mood stabilizer. i have a feeling that the doctor's office (psychiatrist and psychologist who did testing) knows they never considered bipolar or major mood swings before and they should have- but i'm happy with them anyway- it's better than over-reacting to everything a 11 or 12 yo does. it would have made me feel better though, if psychiatrist would have told me all along how much of a shot in the dark all this is. psychiatrist switched difficult child to lithium in spring but that wasn't working well because of times for dosages, blood tests, and a few minor rashes. he just switched him to lamictal about 2 weeks ago- working up from 25 mg/day. i can see where a mood stabilizer might help, even without more of a diagnosis. it has helped to join this forum and find that other difficult child's have been put on the same medication for epilepsy, without having epilepsy. but it is frustrating to know at some point in time, we could have worse problems and psychiatrist say "oops, wrong medications". is there a point when difficult child should stop taking medications and start over with diagnosis and medications? I know when things are working, we shouldn't change them, but when things are in crisis, if everything changes, how do we determine what helped or didn't?


I think it's generally best to start one new medication at a time so the effects can be tracked. Just like when introducing an infant to baby food and they tell you to start one food at a time so you can identify an allergy. They might add another medication to be used PRN (as needed), such as an antipsychotic like risperdal (good in low doses for impulse control), which wouldn't cause a conflict with this strategy.

It does take some time for lamictal to get to a therapeutic dose because they have to increase it so slowly. Lamictal is used as a mood stabilizer, but I believe it's used more for those whose bipolar has more of the depression issues as opposed to it would make sense to use in your kiddo, in my opinion. I'm not bipolar, but I've been trialed on lamictal because of my depression. I was even on risperdal PRN when my depression was severe.

There are no objective medical tests available to test for these disorders. There is no blood test to check serotonin levels, etc. So, there is a lot of trial and error involved. Have you ever read the DSM? So many of these disorders have overlapping symptomology. Then when you're dealing with children and adolescent minds, you have so many other factors playing into it that just further complicates the picture. I've read that statistically the average time it takes for a child with bipolar to be accurately diagnosis'd is 10 years. Keeping a journal of your difficult child's symptoms, a daily mood calendar, something along those lines would be really helpful for the psychiatrists and for you.