Moods up and down, how do you handle it?

[FlowerGarden]

difficult child is on Depakote, Trileptal, and Risperdal. Been on this combo since mid Dec. Depakote is as high a dose as it can be. Teens his age and size are usually on a higher dose but his level goes too high and his eyes start to move as if they are shaking.

About 3 weeks ago, he had become very upbeat and very happy but he started to feel as if he was "going to lose it". He felt his mood dropping slightly and wanted help before it esculated to where he'd get depressed and angry. He did everything he was taught to stay out of the hospital and they wound up putting him in the hospital! The program he was attending declared him a possible danger to himself or others and he couldn't go back there or to his regular school unless we hospitalized him. A nightmare!

The hospital kept him 6 days and everyone said that it was the best they had ever seen him in two years. They all said that they didn't understand why he was admitted. The dr wouldn't change any medications because he was so stable there.

He's been attending the hospital's partial program since his release. His moods were going up and down a bit when he started there but now his moods are creating havoc. He won't get up to go to partial. Says he's tired, hates his life, doesn't care about anything. Once he finally gets out of bed about noon, he is upbeat and almost high. He's gone to partial after getting up so late for it and has cooperated and been very "charming" there. Comes home and is fine but spends most of the evening out with his girlfriend or at another friend's house. He blames us for all the problems he has gotten into in the past because we called the police a few times because of the damage he was doing and the way he'd terrorize me, so he doesn't like to be home much.

Even some of the normal things he has usually done for most of his life have been different the past couple of weeks. Examples: Usually cannot stay awake on a long car ride. Easter he was awake the whole time and at one point started fooling around by taking a water bottle and rubbing it on my hair to make static and have it stand on end (I was in the passenger seat and he was behind me). Has a favorite pie and would it the whole thing if we'd let him and this time he didn't eat any of it.

Once again this morning, I can't get him out of bed because he is so down. They are to the point where they are going to kick him out of the partial program because he is not getting there on time. If they do that, he is not allowed back to his regular school, which is where he really wants to be.

At our family meeting at the partial program the other day, the clinician told us that he is very friendly, caring, funny, charming, but has the temper of a two year old. Also, that when he gets angry and takes it out on me (which is usually the case) that he can't stand to have someone or thing come between us.

Anyone have any suggestions or tips to try?

 

[smallworld]

What dose of each medication is he taking?

Obviously, we're not doctors, but it sounds to me as if his current medication combo is not stabilizing his moods. Depakote is generally great at controlling mania, but it is not that effective for depression. In fact, my two older kids became depressed and irritable on high doses of Depakote, which is why we discontinued it and switched them to Lamictal. In addition, both Depakote and Risperdal are sedating, which could be playing a role in making it more difficult for him to get up in the morning. Or Risperdal could be pooping out, as it can if it is used over a period of time, and you may need to increase the dose or switch to a different atypical antipsychotic.

Don't the partial psychiatrists have any suggestions for you about the medications?

I'm not sure I understand this paragraph:

At our family meeting at the partial program the other day, the clinician told us that he is very friendly, caring, funny, charming, but has the temper of a two year old. Also, that when he gets angry and takes it out on me (which is usually the case) that he can't stand to have someone or thing come between us.

Can you explain?

 

[FlowerGarden]

Smallworld,
He takes 1000mg of Depakote at night, 150mg of Trileptal twice a day, and 2mg of Risperdal twice a day. The dr at the partial program says that she cannot change the dose of any of the medications because she feels he is over medicated for his system. He is extremely sensitive to medications. Side effects are tremendous. Even the clinician there said that he has that "Risperdal look". He looks drugged quite often. His hands shake at times from the Depakote.

difficult child says the combo of these medications have made him feel the best he has in two years. It just seems like he is cycling (don't know if that's the correct word for the extreme highs and lows that are happening daily).

To explain the paragraph you questioned. In partial they are seeing how well he is and what a great personality, etc. Then they see that when he doesn't get his way, he will react with being defiant, "no way am I doing that", kick a table leg, rock back and forth in a chair, whine. He will even scream "AHHHH" as loud as possible just like a two year old who wants mom to buy a toy in the store and she says no.

When he gets angry about having to go to partial, spent all his money but wants to go to the movies with his friends, etc. he takes it out on me. It's always my fault. When he starts with the yelling and screaming at me, usually easy child 1, easy child 2 or husband will come into the room because difficult child has been known to get in my face screaming, blocks my way, whispers things in my ear that are horrible, etc. They'll sit in a chair or on the kitchen counter. This infuriates him more and he'll start swearing at them. Even if I try to go to my room and close the door, he will follow and stick his foot in the door so that I can't close it. If I do get to close it, he pounds on it or kicks it. He cannot stand to have someone come between us by trying to help diffuse the situation or give me support. He can't stand to have a door between the two of us.

We are awaiting residential placement but I just don't know how to handle the ups and downs that are happening so frequently and the being so tired in the morning just sets off problems with the authorities at the partial and school when he is in regular school. Just because he can get up early at times, they feel he should be able to do it everyday.

He has been trying to use a dawn simulator light alarm that can be used as a light box as well. It has a very loud alarm beep with it. He can sleep right through it!

Someone told me that they have a relative with severe mood swings and that their dr adds a medication for the time they are having them. difficult child's dr refuses to do anything with his medications.

I just don't know if I should try to find another dr. I don't know if there is any changes at home that might help him out. I don't know if I should ask his regular high school to do any type of adjustment when he goes back. Partial decided last night that they will release him from the program today and let him go back to his regular school next week. They decided not to terminate him for non compliance.

 

[smallworld]

FlowerGarden, my son was in a partial hospitalization program for 6 weeks in December and January. He was very angry and depressed about going to the program, but as his medications were overhauled, we saw improvement in his behavior and mood at home. As soon as he was released from the program, he began to function just about normally both at home and at school.

I don't think that's the situation with your son. I personally would not accept that this is a good medication combo for two reasons: First, he's aggressive with you. Second, he appears "drugged" to clinicians who have observed him. The goal of medications is to have the patient function as normally as possible with as few side effects as possible.

Changing the medications doesn't need to mean increasing or decreasing what he's already on. It can mean swapping one for another. For example, if he's shaking from Depakote, switch to Lamictal. Or if the Risperdal dose is too sedating, try Seroquel, which is not as "harsh" a medication as Risperdal (according to our neuro). Even though your difficult child says he feels the best he has in two years, you may still need to refine the medication combo. His behavior certainly isn't the best it could be.

In your shoes, I would definitely find a new psychiatrist. You need someone who's going to work with you to help your difficult child be the best he can be.

One other thought: Since he has PANDAs, has a strep test been performed recently to see if that might be a factor in his current mood instability?

 

[slsh]

Flower - wish I had an answer on how to deal with the swings. thank you doesn't live at home and I still have a really hard time dealing with the ups and downs. It's probably different for me because he isn't here, but I try to keep all conversations on a very even keel on my end. Regardless of if he's up or down, I try really hard to be as neutral as possible. I don't know if it helps him but... I don't know. Part modeling good behavior on my part, part trying to be his rock? Does that make sense?

I agree with smallworld. If medications are making him appeared drugged out, in my humble opinion they *need* to be adjusted. One thing that really jumped out to me was 1000 mg of Depakote at night might be why he's not able to get up in the morning. thank you's been on Depakote for*ever* and the dosing and timing has been played with too many times for me to remember them all, but I don't think he's ever gotten just 1 dose per day. He's about 220 pounds now (just for comparison) and gets 250 mg in the morning and 500 mg at night. He had been taking it 3 times a day for quite a long time (8 a.m., 4 p.m. and then 9 p.m.). With your son being so hard to wake up, I'd ask about the possibility of divided doses.

Does he have an IEP at school? Do you have specific thoughts on what might help him be more successful at school? Personally, I'd definitely talk to the school about his morning difficulties - some schools might not handle his tardiness well. on the other hand, if he wants to go back to school maybe that will make your mornings better??

Sorry, wish I had better answers. Can only tell you you're not alone, and second smallworld's suggestion of finding a new psychiatrist if possible. Hang in there!

 

[Hound dog]

I don't think that's the situation with your son. I personally would not accept that this is a good medication combo for two reasons: First, he's aggressive with you. Second, he appears "drugged" to clinicians who have observed him. The goal of medications is to have the patient function as normally as possible with as few side effects as possible.

I also agree with smallworld. I'd say the medications aren't working for him. Maybe it's not the right doses, or (what I'm thinking) is probably not the right medication combo for him.

I know Nichole nearly drove me over the edge when her moods were all over the place. I think because you never had any clue as to what to expect from her.

I did learn trying to reason with her during a rage and such was useless. I could spout consequences til I was blue in he face, didn't matter. I learned to leave that until after the storm had passed and we could talk it over with much less emotion. Same for the manic behaviors.

((hugs))

 

[FlowerGarden]

Thanks for all the support. I have been so drained lately with everything going on with difficult child that I wasn't sure if I was thinking right about this. It feels so good to have such awesome support here. I will start with seeing about the depakote being split into 2 doses. Since the dr won't change any medications, if splitting the dose doesn't work, I'll look for another dr for him.

He's been tested for strep but it came up negative.

He has an IEP (we actually have a mtg this afternoon to go over it). His case manager is awesome so hopefully she will push the lateness issue with the principal. It's the principal that gives everyone a hard time when it comes to IEPs. I actually have sent the article "24 hours in the life of a bipolar child" (not sure if that's the correct name) to the case manager and she made copies of it for certain people in the school to read. Hopefully that helps.

Thanks again for all your support!