Mood Disorder - not otherwise specified - first post

Discussion in 'General Parenting' started by dad_of_3, Aug 28, 2009.

  1. dad_of_3

    dad_of_3 New Member

    Our difficult child is currently diagnosed with Mood Disorder - not otherwise specified. She is missing some key attributes of Bipolar (primarily the mania part).

    The main symptoms we are working on now are depression. She gets into what we call meltdowns over seemingly little things (like taking a shower). It then escalates into crying, whining, pleading. Definitely some defiance in there too or at least inability to reason. The cycle is generally this:

    Hysterics (crying, arguing)
    Remorse (pleading, crying)
    Sleep (sometimes)
    Back to normal

    30 minutes is a typical duration, then it's like it never happened.

    She is on 20 mg of Prozac and 1.0 mg of Risperdal (recently increased from 0.5 mg).

    Not sure what I am asking here other than does anyone else experience these types of cycles, usually 4 -6 in a week, sometimes more than one in a day?

    Also, any experience with this combination of medications?

    She's 10 years old and it breaks my heart to see her in such distress but this is taking a toll on the family.
  2. slsh

    slsh member since 1999

    Hi Dad and welcome-

    My difficult child was an ultra rapid cycler, up and down and all around multiple times a day. His rages could last for hours. We finally got a bipolar diagnosis at age 6 and started a mood stabilizer (Depakote) along with Risperdal. Within 6 weeks of starting the mood stabilizer, we went from multiple cycles a day to multiple a week to, at his best, generalized irritability and defiance (but manageable) for 2 months and then 1 month of gradual escalation to a major meltdown (usually requiring hospitalization due to homicidal or suicidal gestures). Hmmm... rereading this, I'm sure you're thinking you probably *don't* want to consider our experience, LOL.

    But seriously, in kiddos with mood disorders, a mood stabilizer is generally considered the first line defense. It's really difficult because I think in hindsight depression also was a huge contributor to my son's struggles but generally speaking antidepressants are iffy in the pediatric population. I'm partial to mood stabilizers because a lot of them have been used in children with epilepsy (Tegretol, Depakote) so there's at least some clinical data on side effects and reactions. Over the years, we tried a couple of antidepressants/antianxiety medications - he had a very stable period for a while on the combination of Depakote, Celexa, and Risperdal (which over the years did a decent job of curbing his violence). As a mid teenager, propranolol, Risperdal, and Depakote held the cycling down and also curbed his tendency towards violence.

    My son also would flip over the most innocent of requests - take a shower, brush teeth, get dressed. Again in hindsight, I think it wasn't the request specifically that would trigger him. It was that I was making a request, period. That oppositionality is a real bear and I can't say that we ever figured out how to manage it (nor did staff in his placements). It's still a huge issue for him, which of course makes employment an interesting proposition. ;)

    Anyway - just our experience. Unfortunately, all our kids are different and there's no sure tried and true medication combo or therapy that works for everyone. Much of it is trial and error. You're certainly not alone in dealing with- a kiddo who cycles frequently. It's exhausting.
  3. compassion

    compassion Member

    Welcome Dad, my daughter is a rapid cycler. Yesterdy she was almost normal today, she was expressing the symptoms you described. She ia on atypical anitpychotic and a mood stabilizer. It helps but it is still challenging. Today she was crying a lot, all over the place with irratibilty, depressive expressions. She makes a lot of demands and therats when she is like this:perservates on a particular demand, Today it was about 7 hours of going over and over the same demand (more money) . She called me 40 times! She is away for the weekend so that is a relief. I have learned to stay calm, to try and take care of me. I cannot reason with her when she gets like that.
    CABF (Child and Bipolar Foundation), Nami, Al-anon and Fa have been helpful for me. Plus, reading a lot about pediatric bipolar, espeically rapid cycling has helped. It is not easy. Luckily, we do not have to walk alone. Acceptance has helped a lot for me.
  4. flutterby

    flutterby Fly away!

    That sounds just like my daughter at that age and she is not bipolar. Her current therapist has bipolar in the back of her mind, but I know in my gut she is not bipolar. For one, she has never experienced mania or hypomania and for another AD's haven't made her manic.

    When one is depressed it takes everything you have to just to get through the day. When asked to do something you just can't cope with - even something as innocuous as taking a shower - I can definitely see the cycle that you talk about with your daughter. My daughter's meltdowns would last from 45 minutes to several hours. She also has severe anxiety contributing to her issues.

    Have you tried giving her time to switch gears? IOW, instead of saying it's time to get a shower now, give her a 15 minute warning, then a 10 minute warning, etc?
  5. TerryJ2

    TerryJ2 Well-Known Member

    Welcome, Dad of 3.
    You've gotten some great ideas here. I know what you mean about how it takes a toll on the family.
    Just wanted to lend support.
  6. susiestar

    susiestar Roll With It

    Welcome, Dad cubed. I am so glad you found us, and sorry you needed to look for us.

    Have you read "The Bipolar Child" by Dmitri Papalos? How about "The Explosive Child" by Ross Greene, "Parenting with Love and Logic" by Fay and Kline? "The Out of Sync Child" by Kranowitz? "What Your Explosive Child is Trying to Tell You?" by Dr. Riley.

    These are ALL books you should at least skim. Many of them wouldbe an awesome investment in learning to help your daughter. Of course the library should have most of them that you can borrow or read at the library. Chances are you will want to look back over them periodically.

    The Bipolar Child, the out of sync child and the explosive child are the three that you really NEED. The out of sync child deals with Sensory Integration Disorder, meaning that the child does not process sensory input in the "normal" ways.

    Who diagnosed your daughter? Has she seen a neuropsychologist for in depth testing? A GOOD neuropsychologist will spend 6-10 hours over several days testing her. It is a way to get to really discover what is going on.

    If you look in the FAQ/Board Help section of this forum you will see a thread titled "Parent Input/Multidisciplinary Evaluation" It has a guideline that will help you get ALL the info about your difficult child in ONE place. I highly recommend doing this. You will have to do the report in sections - NOT all at one time. It will let you keep track of everything and be able to communicate specifics to teachers, doctors, therapists, etc... Do NOT give a copy of everything to the school. In MANY cases they will use at least part of the report against you. Or twist it to justify not giving him all the services he needs.

    Well, that was quite a book. I can get long-winded, LOL!

    I hope you have a great weekend and can do some research on some of this.

  7. dad_of_3

    dad_of_3 New Member

    I would like to thank everyone who responded for the detailed and insightful posts. I know it's corny to say this, but it's good to know you are not alone.

    I have got some of the books mentioned and will be reading those as fast as I can. The psychiatrist also recommended that we change the time of day for the Risperdal from morning and evening to morning and afternoon since most of the episodes occur in the late afternoon or early evening.

    We have another psychiatrist appointment tomorrow to discuss this further. I also need to find a new therapist in the sf bay area as my difficult child and her current therapist are at an impasse. She is essentially tuning her out, not unlike us!

    Today was the first day of school, where she is typically well behaved. She usually saves it all for home. We'll see...

    Thanks again to everyone who replied.
  8. TerryJ2

    TerryJ2 Well-Known Member

    How did it go today?

    Sorry about the therapist. You'd think the therapist could find a way "in." I mean, that's her job. We spent a few sessions with-our difficult child's therapist where difficult child did nothing. Huddled on the couch with-husband, hid his face, refused to talk, etc.
    I don't recall the definining moment ... I think it was more of a gradual thing.
    One time, I did not give difficult child his medications, and he was more aggressive, and wanted to play on the therapist's computer. I remember one really neat interaction, where the therapist kept difficult child away but promised he could print out something if he did XYZ first. (I don't recall what it was.) It was definitely a more give-and-take than what I was used to, and of course, the therapist stayed calm the entire time, more than I did back then, LOL!
  9. dad_of_3

    dad_of_3 New Member

    Today went well. We are going to try a higher dose of Risperdal and got more recommendations on a therapist. Our former therapist was good, but she had been treating our difficult child for three years and I think they both needed the change because whatever used to work was no longer effective in getting through to her. That is another frustrating part of this experience, our difficult child knows the methods and suggestions that her therapist and her parents are giving her are fundamentally sound but when she loses it, reason goes out the window as well.

    Yesterday (also first day of school) was particularly rough. School went well as usual but it was game on when she got home. Two huge meltdowns over the silliest things. The first was because we were not having tacos for dinner but rather rigatoni (which is far superior in my humble opinion). The second was about taking a shower (even with ample warning).

    Anyway, the psychiatric is attentive and feels we are on the right track, now I just need to find a new therapist and that is not easy. I hate my difficult child going through the churn of medication and doctors.

    Thanks for checking up on us.
  10. Christy

    Christy New Member

    Welcome! I'm glad you've found us. As a mom of a bipolar child, I feel you pain, frustration, worry, etc... My son takes risperdal and it has been a good medicine for controlling his rages. He did very poorly on antidepressants as they caused a great deal of irritability. I know that some individuals with bipolar disorder can take antidepressants while others cannot. Have you see improvement with the prozac? Are things getting better, worse, the same? It helps to keep a journal of moods and behaviors so that you can begin to see a pattern or cycle if one exists. The book recommendations are good ones and should help shed some light on the struggle your daughter and your family is going through. In addition to this sight, my local NAMI chapter has been a huge source of support and understanding. I understand your relief at not being alone. Raising a difficult child can be an isolating experience.

    Look forward to hearing more from you,
  11. Momslittleangels

    Momslittleangels New Member

    My daughter was diagnosis with bipolar when she was 16, but to this day, I still think she is more on the Pervasive Development Disorder spectrum (Pervasive Developmental Disorder (PDD)). The one thing that stuck out in your comment above was the dinner issue (and it could have been anything), but it shows some rigid thinking patterns. My daughter would get "stuck" on one thing and that is all that mattered (we called it her "tunnel vision" way of thinking). The same with transitions or changes in plans. If something was suppose to happen a certain way, then it had BETTER happen that way, or there would be meltdowns. If the schedule at school said lunch started at at 12:00, then it had better not start at 11:59 or 12:01 or she would be nagging the teacher and telling the principal. She was not afraid to make it known that things weren't being done the way she was told it should. And again, it could have been about any situation, I am just using that as an example.

    So, when I saw your comment about the change in dinner plans, it made me think about Pervasive Developmental Disorder (PDD) and perhaps it is work looking into. I hope things settle down with the after school issues, but she is probably having trouble transitioning between school and home. Maybe if there was one thing that was routine when she got home, it would help her settle in better (maybe she knows that she can watch her favorite show for 30 minutes before doing anything else or have a snack or something along those lines). Also, have you ever tried making a schedule for the evenings, so she knows what to expect? If she is truly on the Pervasive Developmental Disorder (PDD) spectrum, she might function better under those parameters.

    Just a few thoughts.
  12. susiestar

    susiestar Roll With It

    Sounds like a good appointment. None of us like the therapist, psychiatrist, medication wheel but it is what will help our kids.

    Has the doctor suggested a mood stabilizer or have you asked about one? If mood disorder of any type is the diagnosis then the child should NOT be on an antidepressant and an atypical antipsychotic. The child should be on a first line mood stabilizer and the atyp. antipsychotic.

    There is a board who certifies child and adolescent psychiatrists. This is THEIR guideline, NOT ours here. Sadly many many many docs rx the SSRI and SNRI medications instead of mood stabilizers. The SSRI and SNRI medications can make things HUGELY worse and even then lots of docs want to increase them.

    I have long been stymied by this. If this was MY child I would research mood stabilizers and then search for the protocol for treating Early Onset Bipolar and insist on using that. The Bipolar Child will have the protocol and it is well explained in the book.

    This site seems very good at explaining things: It has descriptions of the mood stabilizers and it tells how the guidelines were established.

    Hopefully this helps.
  13. TerryJ2

    TerryJ2 Well-Known Member

    I'm with-Momslittleangels on this one, in regard to the dinner episode. How about if you try NOT telling her what's for dinner and see what happens? My difficult child would complain LOUDLY and sometimes have a total meltdown if dinner was slightly off from what he expected. So I started telling him that I wasn't going to tell him, because he would always have a fit.
    He hated that. Hated the lack of control, hated not knowing. Now, we were way deeper into our therapy than you are at this point, but still, it's worth a try to see what her reaction is.
    Also, sometimes I would say that something was going to be made for dinner, and I was really looking forward to it, only to discover that we didn't have the ingredients on hand. I would shout, "OH NO!" from the freezer or pantry (with-my head inside :) ) and stomp my feet and wail and announce very loudly that we didn't have the ingredients. difficult child was so alarmed by my behavior that it completely took the wind out of his sails and he didn't complain. It was pretty funny.
    That won't work now. He's older and he'll just roll his eyes and say, "So, just go to the store and get it." Smarty pants. :)
  14. dad_of_3

    dad_of_3 New Member

    I would like to reiterate my thanks to all of you for the great responses. Now if I could only stay awake long enough to read all the books I checked out!!

    Momslittleangels, your points are well taken on Pervasive Developmental Disorder (PDD) and I am trying to get things structured that way. Things are fairly well ordered in the evenings; bathing, brushing, reading, bedtime are consistently done but I may need to go one level deeper with an actual schedule.

    On a good note, she was able to control herself just about 20 minutes ago and did not let it escalate to the normal level. Still counts as an episode on the chart I am keeping but the magnitude was way less than usual.

    susiestar, thanks for the info on the medications. I completely agree with you that the patient (or their parents in the case) need to be as informed as possible. I went through this myself (I have Ulcerative Colitis) and had to change doctors a couple of times to get the best possible treatment.

    have a great weekend.
  15. midwestdad

    midwestdad Lost

    Welcome again, Do3. We also have major meltdowns over very small things, including those same shower and brushing teeth items. I hope the therapy goes well, and that you can find some success between that and the medications. They can all be very daunting, there are not only dozens of dxs that can cover our difficult children, Each one has many different medications and medication combinations. Some of the people on these boards have been through hundreds of changes. Getting through it is tough, but the people here are supportive.
  16. rlsnights

    rlsnights New Member

    quick thoughts - have very similar experiences with difficult child 2 and have seen much improvement:

    1. speech assessment? turns out mine has language issues only revealed with thorough assessment by independent speech path - look for non-literal and pragmatic issues
    2. deep muscle activity first thing when she gets home and any time she starts escalating - tug of war is very popular at our house. very calming but may be activating too so you will have to be the judge. if too activating, try rolling her tightly in a blanket or sheet cover with pillows and have 7 yo sister lay on top or do something else to add pressure. if this works, then giving her physical activity that works the proximal joints (shoulders, hips) daily may help - fill pillow with beans for her to carry, have her move heavy boxes, pull-ups on a chinning bar, push-ups on the wall, wheelbarrow races (hold her feet while she walks on hands)
    3. is she clumsy, seem to have sensory issues? if so, Occupational Therapist (OT) assessment may be helpful
    4. create set schedule for as many things as can be reliably scheduled like showers. make it a pattern that she is used to. you may get blow ups when pattern is broken but if it's something that's likely to be workable (showers before bed for example) than it may be more helpful than not. requires parents to acknowledge need for rigid scheduling.
    5. in my humble opinion if she is clearly cycling (hypomania is harder to recognize in kids than in adults - often includes defiance which is grandiosity - I'm on the same level as adults, irritabililty, poor impulse control, poor sleep - all of which you seem to describe - trial of mood stabilizer would be on my list ASAP. Try this website for more info on ways to think about "bipolar" that, in my experience, more accurately describes the extreme variability of BiPolar (BP). It's not just Manic - Depressed and sometimes normal. In fact very few folks have this manifestation of BiPolar (BP).
  17. Chubbysanta

    Chubbysanta Sad Dad

    Just wanted to add a welcome to you , is the defiance a big issue? cause it could be Oppisitional defiant disorder or ODD just from what you described in your first post. once again welcome