Need help ASAP! Have to decide about Lithium NOW

[nvts]

Hi Guys! Please give me an answer/suggestion re: lithium. difficult child 1 is in the psychiatric hospital. and finally started cycling for them (took a week + to do so). They're suggesting lithium to quell the impulsivity and the hypersexual comments and gestures (he's 12 by the way). They explained that this points them toward a bi-polar diagnosis.

Questions:

1. has lithium helped?
2. are you aware of alternative medications?
3. his HbA1C is elevated from the risperdal - I'm worried about him developing diabetes (I'm a type 1 diabetic so the potential is high). Are you aware if lithium elevates blood sugar?

They want authorization in the next hour or so, but even if I pass the deadline and have to make the decision, please give me your input.

Thanks all of you! As usual, forever in your debt!

Beth

 

[busywend]

I do not know much about it, but I feel like I have heard mostly positive results from it.

hopefully someone more medication smart will pop in!

 

[rlsnights]

Lithium is generally the medication of choice to treat mania. If it is going to work it works quickly and usually pretty well. Our psychiatrist told me that recent research has favored the atypical antipsychotics for managing early onset bipolar but he's already on that and it's not working. The biggest side effect issues with Lithium are hypothyroidism (thyroid levels need to be checked before starting and regularly while on lithium) and damage due to elevated serum levels often caused by dehydration. With lithium it is *very* important to stay well hydrated and to be very familiar with the early signs of toxicity so that prompt treatment of the toxicity can be done. If those things are done my experience and reading suggest it is as safe as any of the psychiatric drugs and, unlike lots of the others, has a very well documented rate of successful treatment.

If the lithium works well I would try to drop the risperdal. My son was on Abilify and it drove his blood sugar levels way up above 100, caused him to gain about 30 pounds and produced liver and red blood cell abnormalities. It's my feeling that Lithium is likely to be lower risk than risperdal for your son but of course you will need to discuss that with his doctors.

Did they offer you any alternatives like a mood stabilizer? Topomax, Lamictal, Depakote? Or as an add on instead of risperdal?

As for them demanding an answer within an hour, all that means is that the psychiatrist on duty is going to be gone in an hour and he wants to order the medications before he leaves. It is an artificial deadline and you have the right to take your time before deciding and to ask as many questions as you need to before deciding. They can always call the doctor after he leaves for auth to give the medications. And, if you haven't dealt with this before, they should require that one of the staff "witness" your agreement so 2 different people should be asking you if you agree to the medication change.

Patricia

Patricia

 

[zba189]

I have been reading The Bipolar Child and here is the information about Lithium that it gives (condensed)

1- "In adults, no one knows for sure how it exerts its effects, or why it works preventively in both mania and depression". It works better when not rapid cycling, but even though children rapid cycle (for the most part) many have an excellent response to the drug or to its use in combination with another mood stabilizer.

Here are the listed side effects:

Early- Nausea, vomiting, diarrhea, abdominal distress, headaches, excessive thirst, frequent urination, and bed wetting. (these can be dealt with by adjusting the dose).
Other side effects- Hand tremor, Weight Gain, Acne, Hypothyroidism, cognitive problems (short term memory problems). Also there could be some issues with kidney functions and calcium levels need to be watched.

Other medications that fall into the same category are: Tegretol, Depakote, Gabapentin, Lamictal, Topamax, Gabitril, and Trileptal.

I hope I've helped, I tried my best to answer your questions. I don't have first hand information about Lithium. The book has a ton of really good information about drugs and what they do and what they interact with.

 

[HaoZi]

Trileptal seems to be working pretty well at leveling my kid now, and it does not have all the extra side effects (or require regular blood draws) that most BiPolar (BP) medications do. Salt craving seems to be the main side effect that comes up, because it works in the sodium channels of the brain.

 

[DammitJanet]

Beth, lithium worked the best out of everything we ever tried for Cory. That said, he did develop hand tremors on it and he also had to start taking synthroid after about 6 months. After he came off the lithium he was able to stop the synthroid but the hand tremors have remained.

Cory has always been one to drink fluids so we didnt have a problem with hydration and another thing to remember is to not cut down or increase his salt intake because lithium is a salt so you want to keep things even. Dont suddenly drastically cut out all salt or increase it. I mean like if the kid is used to chips and salting his food, dont take it away because he is on lithium.

 

[slsh]

Another one who's kiddo developed thyroid problems on lithium (monster goiter - we're talking just huge). He also was on Synthroid for a couple of years.

My personal bias would be going for Depakote or Tegretol as mood stabilizers first. While lithium is the gold standard in adults, there was not a huge database on pediatric use when thank you started it (he was started on it because they felt that he needed it on top of Depakote - new psychiatrist in Residential Treatment Center (RTC) #1 - it never did make a difference and I adamantly requested that the lithium be stopped when the goiter developed). With Depakote and Tegretol, at least you have the data that's been developed over the years because those medications are also used in kids with- epilepsy.

Just my 2 cents.

 

[smallworld]

Lamictal and Trileptal are also used in kids with epilepsy. I would be cautious with Depakote in a child with a predisposition to diabetes because Depakote causes weight gain. It would be better to go with a mood stabilizer that is weight-neutral like Lamictal or Trileptal.

 

[kfmewes]

I have never taken Lithium but, I am bipolar and I take Lamictal and it works pretty well for me but, I can't really be much help in what to give a child.

 

[flutterby]

Personally, I would prefer lithium and/or lamictal (they are frequently used together) over the other medications.

 

[Wiped Out]

I've heard great things about Lithium but it wasn't for my difficult child. My difficult child did develop hypothyroidism on Lithium. For him he was drinking water constantly as well as urinating a lot. He started wetting the bed while he was on it.

 

[Steely]

You said you had an hour, so let us know what you decided to do. FWIW Lithium was a God send for Matt for a good 6 years. He later decided to go off of it because he had some thyroid side effects, but for years it worked really, really well. I would try it.

 

[DammitJanet]

I was recently told they were starting to remove depakote from patients especially kids. Moving them all over to other MS's. Just a FYI.

 

[nvts]

My update disappeared! Weeble must have done something...

I told them that I didn't want to make the decision until I could talk to his psychiatrist (there was a stand in yesterday - difficult child 1's was on vacation) about my concerns.

I don't know what it is about lithium that scares me. It's just that "needling" in the back of my brain that keeps pushing it's way to the forefront. Nothing I read is any scarier than any other medications. It just has a scary feel. You've all helped a lot, and truthfully, I'll probably decide to trial it...it's just something in my gut/brain that keeps making me revisit it - over and over and over again.

Truthfully, for the first time in my life - I sat down with a Dewar's and Club, sipped and read ALONE! I just needed to kick back and do something for me to feel a bit o' serenity. It took me 45 mins. to finish, it was a short little glass, but it just allowed me to slow down, take a breath and read (granted - it was all the medication info. that I dug up - no bodice ripping drama for me!).

I'll keep you all up to date! As usual, thank you all for being there for me!

Beth

 

[rlsnights]

Lithium is the only psychiatric medication I can think of that has become a household word. And it has, perhaps like ECT, come to be associated with only the most severe mental illness - i.e. "crazy". Maybe that association is contributing to the uneasy feeling you get when you think about putting your child on it.

I thought of this because of my sister. She recently underwent a course of ECT for very severe depression. She and I talked about this decision a lot because it was a very difficult one for her to make. One reason she identified as scary about ECT was the fact that it is widely seen as a treatment of last resort for the "truly crazy". This meant that she (a mental health professional herself) was among the "truly crazy".

So I just thought I'd offer this possibility FWIW.

I am not suggesting that you dismiss your mom-gut feelings on this subject. I am a firm believer in the mom-gut guide.

Sounds like you made a decision you are comfortable with and that you grabbed some much needed time for yourself. Hope it's a bodice-ripper next time.