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Need Info About SSRI and AP Medications
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<blockquote data-quote="rlsnights" data-source="post: 412973" data-attributes="member: 7948"><p>t I think you have some very mixed signals here about his response to the Zoloft that would benefit from a comprehensive neuropsychologist assessment. Going ahead with medication trials sounds like it needs to happen but additional assessment also seems called for.</p><p></p><p>Normally (if you can use that word and psychiatry in a sentence together) the diagnosis dictates treatment. But there is a constant process of reconsideration of diagnosis given response to medications or changes in behavior/thought/mood.</p><p></p><p>Practical things you can do now are to educate yourself on the things that the psychiatrist is suggesting he's thinking are happening. So reading up on early onset bipolar, Obsessive Compulsive Disorder (OCD), intermittent explosive disorder, Tourette's if the doctor thinks that may be underlying may provide you the tools to help sort out what's happening.</p><p></p><p>In terms of practical help, I suggest you get a copy of The Explosive Child and read it tonight. It will help you develop a plan for coping with these difficult behaviors now.</p><p></p><p>If the psychiatrist hasn't already done this with you, I suggest you create a mental health family tree. There are a number of online programs that do health family trees including on the Surgeon General's website if you want to use one of those. Otherwise you can just make a list. It may require that you ask some uncomfortable questions among the extended family but it may help you and psychiatrist a lot. You want to go back to at least grandparents and their sibs. If you can get info on earlier generations, even if the info is vague, that is really good. That's because a lot of the time (not always of course) there is a family pattern of mental illness.</p><p></p><p>The things you want to include are</p><p></p><p>1. Diagnosed mental illness including Obsessive Compulsive Disorder (OCD) and mood disorders like depression, etc.</p><p>2. Undiagnosed or untreated mental illness that is open knowledge or hinted at by family members. This would include things like Great Uncle Ben's nervous breakdown, Aunt Grace's whopper spending sprees or any mention of an extended family member needing valium or other treatment for their "nerves".</p><p>3. Addiction issues even if only "hinted" at by family members. This includes alcohol and rx and non-rx/illegal substances</p><p>3. Neurological disorders like seizures or tremors can be helpful too</p><p></p><p>It is a good idea to keep a diary of signs and symptoms for at least a month. Many people keep them all year round so they can identify patterns that are longer than a month. You can just write out what the day was like or you can use a number scale like 1 to 5 to describe certain behaviors/moods. Given the psychiatrist's concerns and your experiences, you should probably include a note/estimate of what his mood that day. Rate his "negative" or down mood and "positive" or up mood separately rather than try to give an overall. Irritability can be a good thing to track. Activity level and amount of sleep. Severity of Obsessive Compulsive Disorder (OCD) sx. Whether he raged that day. You also want to note whether he tooks his medications or if there was something different about his medications like a change in dose or a missed dose. And you want to note briefly any special/unusual events like a birthday, big changes in health of pets and family members, etc. Anything that's significantly out of the normal for his daily routine.</p><p></p><p>If he did not have a "washout" period between the change of medications then I think you should talk to the psychiatrist about doing this. You don't have a good baseline without that which makes it tough to know what's SE's and what's "real" so to speak. If you are worried that his Obsessive Compulsive Disorder (OCD) will get really bad during that time, consider timing it for a vacation week like Spring Break or at least over a long weekend so it doesn't impact his school attendance.</p><p></p><p>Unfortunately, there is pretty good evidence that antidepressants can have a kindling effect on kids who eventually end up with a bipolar diagnosis. That means they tend to provoke or worsen the onset of the illness. Your description could be interpreted as evidence for that but I think you really need more info before jumping to that conclusion.</p><p></p><p>As for medications, the older AP's do not have the metabolic SE's that most of the Atypical AP's come with. Geodon appears to be the most weight-neutral of the newer AP's. In my personal experience, all the classes of psychiatric medications I have tried (pretty much all of them) can cause tremors if you have an underlying tendency/vulnerability. </p><p></p><p>As others said, there are several other choices for a mood stabilizer than Lamictal. Topomax for example may lead to weight loss and is used to treat Migraines.</p><p></p><p>If your son isn't already in therapy of some kind I strongly suggest this. He is probably really upset/scared by the rages and needs help dealing with those feelings. If these are signs of onset of a major mood disorder he (and the whole family) need therapy in my opinion.</p><p></p><p>Good luck. It can be a long process to sort this out. To tweak medications often takes several months or longer and about the time you find the "perfect" balance something happens (like puberty) that throws it all out of whack and you have to start all over again.</p></blockquote><p></p>
[QUOTE="rlsnights, post: 412973, member: 7948"] t I think you have some very mixed signals here about his response to the Zoloft that would benefit from a comprehensive neuropsychologist assessment. Going ahead with medication trials sounds like it needs to happen but additional assessment also seems called for. Normally (if you can use that word and psychiatry in a sentence together) the diagnosis dictates treatment. But there is a constant process of reconsideration of diagnosis given response to medications or changes in behavior/thought/mood. Practical things you can do now are to educate yourself on the things that the psychiatrist is suggesting he's thinking are happening. So reading up on early onset bipolar, Obsessive Compulsive Disorder (OCD), intermittent explosive disorder, Tourette's if the doctor thinks that may be underlying may provide you the tools to help sort out what's happening. In terms of practical help, I suggest you get a copy of The Explosive Child and read it tonight. It will help you develop a plan for coping with these difficult behaviors now. If the psychiatrist hasn't already done this with you, I suggest you create a mental health family tree. There are a number of online programs that do health family trees including on the Surgeon General's website if you want to use one of those. Otherwise you can just make a list. It may require that you ask some uncomfortable questions among the extended family but it may help you and psychiatrist a lot. You want to go back to at least grandparents and their sibs. If you can get info on earlier generations, even if the info is vague, that is really good. That's because a lot of the time (not always of course) there is a family pattern of mental illness. The things you want to include are 1. Diagnosed mental illness including Obsessive Compulsive Disorder (OCD) and mood disorders like depression, etc. 2. Undiagnosed or untreated mental illness that is open knowledge or hinted at by family members. This would include things like Great Uncle Ben's nervous breakdown, Aunt Grace's whopper spending sprees or any mention of an extended family member needing valium or other treatment for their "nerves". 3. Addiction issues even if only "hinted" at by family members. This includes alcohol and rx and non-rx/illegal substances 3. Neurological disorders like seizures or tremors can be helpful too It is a good idea to keep a diary of signs and symptoms for at least a month. Many people keep them all year round so they can identify patterns that are longer than a month. You can just write out what the day was like or you can use a number scale like 1 to 5 to describe certain behaviors/moods. Given the psychiatrist's concerns and your experiences, you should probably include a note/estimate of what his mood that day. Rate his "negative" or down mood and "positive" or up mood separately rather than try to give an overall. Irritability can be a good thing to track. Activity level and amount of sleep. Severity of Obsessive Compulsive Disorder (OCD) sx. Whether he raged that day. You also want to note whether he tooks his medications or if there was something different about his medications like a change in dose or a missed dose. And you want to note briefly any special/unusual events like a birthday, big changes in health of pets and family members, etc. Anything that's significantly out of the normal for his daily routine. If he did not have a "washout" period between the change of medications then I think you should talk to the psychiatrist about doing this. You don't have a good baseline without that which makes it tough to know what's SE's and what's "real" so to speak. If you are worried that his Obsessive Compulsive Disorder (OCD) will get really bad during that time, consider timing it for a vacation week like Spring Break or at least over a long weekend so it doesn't impact his school attendance. Unfortunately, there is pretty good evidence that antidepressants can have a kindling effect on kids who eventually end up with a bipolar diagnosis. That means they tend to provoke or worsen the onset of the illness. Your description could be interpreted as evidence for that but I think you really need more info before jumping to that conclusion. As for medications, the older AP's do not have the metabolic SE's that most of the Atypical AP's come with. Geodon appears to be the most weight-neutral of the newer AP's. In my personal experience, all the classes of psychiatric medications I have tried (pretty much all of them) can cause tremors if you have an underlying tendency/vulnerability. As others said, there are several other choices for a mood stabilizer than Lamictal. Topomax for example may lead to weight loss and is used to treat Migraines. If your son isn't already in therapy of some kind I strongly suggest this. He is probably really upset/scared by the rages and needs help dealing with those feelings. If these are signs of onset of a major mood disorder he (and the whole family) need therapy in my opinion. Good luck. It can be a long process to sort this out. To tweak medications often takes several months or longer and about the time you find the "perfect" balance something happens (like puberty) that throws it all out of whack and you have to start all over again. [/QUOTE]
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