New here - question about Depakote

Discussion in 'General Parenting' started by nessa57, Nov 15, 2007.

  1. nessa57

    nessa57 New Member

    I have a 12 year-old boy whose diagnosis at this time, I guess, is mood disorder not otherwise specified. He has always been a very bright child who did well in school with no behavior problems. In elementary school he was often bullied and didn't do too well with having friends, but seemed to get along with most of the kids most of the time while in school. He has always been very sensitive and thin-skinned. Last year, in sixth grade, he blossomed socially and had a lot of friends and was always busy. He always made honor roll and things were going well. Towards the end of the summer, his friend base began to deteriorate. Around the 2nd week of school, the group of "friends" ostracized him. He was devastated and that has led to a severe downward spiral.

    He was on fluoxetine over the summer for supposed depression (suggested by his former therapist). It seemed to make him hyper and we finally took him off of it at the end of the summer. When the issue with the friends occurred, he began having extreme irritability and mood swings. The psychiatrist put him on trileptan, but he developed an allergic rash and had to be taken off of that. All this time he has also been getting headaches - sometimes migraines. The moods were getting worse, so the psychiatrist put him on 500mg Depakote. He has been on it for a little over 3 weeks. The headaches have improved a lot, but the moods have not. He has frequent meltdowns that include saying he wants to die, life is not worth living, he can't go on like this, etc. School has become a very difficult place for hime to be, but he behaves himself just fine there. I have made the school officials aware of his problems and I know they are keeping an eye on him.

    He has been refusing to see a therapist (wants me to just make all of his problems go away), but I am hopeful that that is about to change. He never clicked with the previous therapist and it turned him off from talking to anyone He doesn't want anyone else to know his problems and is convinced that no one can help him. We have an appointment this afternoon with a new therapist recommended by the psychiatrist and the social worker at his school. My husband and I met him and like him and I hope my son will talk to him. If he does not, I'm afraid we are getting close to having to hospitalize him. He behaves like a 5 year-old, not an intelligent 12 year-old. He is difficult to reason with. When I can't solve his problems, he has a meltdown. These meltdowns can last 1-2 hours and are very exhausting emotionally. He hasn't destroyed anything or hurt anyone, but I know he wants to.

    All has gone rapidly downhill in only the past 6-8 weeks.

    How long should it take for the Depakote to have an effect? What are others people's experiences? I don't feel we have the time to stop this medication and try yet another. I am fearful that he will eventually follow-through on his threats to harm himself. The only thing the docs say is to take him to the ER. I asked the psychiatrist about adding an antidepressant to the Depakote, but she wants to wait a little longer. She said the Depakote would take at least 3 weeks to start showing gradual improvement.

    Keeping my fingers crossed that today may be the start of a turning point. If not, I don't know what to do.

  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Is all of this because of his friends? I have bipolar, which is waht mood disorder_nos usually means in a child (there is no DSM for childhood bipolar). It doesn't happen because of a downturn in circumstances. I would want a second opinion from a Psychiatrist (with the big MD after his name).
    If it turns out that the Psychiatrist thinks the Depakote is a good idea, it takes a full eight weeks on a therapeutic dose for the medications to kick in. I would not rush to put him on a ton of medications. My psychiatrist likes one at a time so he can see what the medication is doing. He can't monitor that if he adds and subtracts medications at the same time. I learned a lot on the long, tiring path to the right diagnosis. with my own son. And the lessons I learned were: Always get a second opinion from the most credentialed professional AND take it slow with the medications. Two professionals diagnosed my son WRONG...please make sure you feel good about what the doctor is saying. No, they DON'T have all the answers and are NOT always right which is why I highly recommend second and even third opinions. Take care and good luck.
  3. nessa57

    nessa57 New Member

    I guess I misspoke. I'm still getting used to the abbreviations here. The Depakote and other medications were prescribed by a psychiatrist who really seems to know what she's doing. We live in the greater Boston area and she trained at Children's. Unfortunately, difficult child has refused to see her or a therapist for some time now, so she's been going on what I tell her. I'm hoping that will start to change with the new therapist.

    Yes, the issues with his friends seem to have triggered the current behavior, but there were signs before that all was not well. His reaction to the continued ostracism and name calling is way out of proportion. He should be upset and sad, but it is way more than that. As I said, he has major meltdowns several times and week and often says he wants to die.

    Thanks for the support. He hasn't had any blood work to determine his blood levels for the Depakote. He is pretty small for his age and the doctor feels this is a good dosage for the time being.
  4. Josie

    Josie Active Member

    Did all of this start when he stopped taking the fluoxetine?

    What was he like before he was on any medications?
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hon, is he on 500 mgs. once or twice a day? I'm asking because 500 mgs. alone may be a bit low for good results. My son was on 1000 mgs. when he took it. I don't think Depakote goes by size. I think it's dosed according to blood level and how well the child is doing, but it DOES take a good eight weeks to see if it's working.

    If he has shown signs of a mood disorder before then I think you're a great mom for getting him help--sounds like he is seeing the best possible person. Keep us updated on your son, and I hope that this all works out for him.
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    OMG, that's a good question about the Prozac too. There is something called "SSRI withdrawal." Was he weaned slowly? I'm sorry to be a Sometimes I think I've been through so much with my son that I never want ANY other mom to go through what we I just want everyone's child to be all right...
  7. gcvmom

    gcvmom Here we go again!

    My 10yo started Depakote ER at the beginning of July, and it took a full 8 weeks for us to see any change in him. And then he ended up increasing the dose over the subsequent weeks and it took a good week at each level to notice much of a change. He's now at 1,000mg and appears to be doing better now, but does have "off" days especially if he's overtired or not eating well. He didn't have the depressive symptoms like your son, but was more on the manic end, but with lots of explosive irritability and obsessive thoughts. He also has ADHD.

    I agree with the others that it's important to give the medication a fair trial (enough time) before making any changes, and to only work with one medication at a time. Your psychiatrist is the best resource for managing the medications, but that doesn't mean you can't also use a psychologist or other therapist who's a better match for your son's cognitive/behavioral therapy. In my opinion, the more eyes that are on your son, the better for figuring out what he needs faster.
  8. susiestar

    susiestar Roll With It

    The first thing to know: We care. We may give you a lot of suggestions or ideas, but we will not be judgemental or take offense if you don't take our ideas. This is a real "soft" place for parents of troubled kids.

    Second: With ANY medical condition, the ONLY way to know what is working is to make ONE change at a time and to give it time to work. I know on so very many levels how hard and frustrating it is. And sometimes it is impossible to do, but it is the best, IF at all possible.

    If your son will not see the doctor, have you gotten an appointment for a new doctor (most male difficult children do well with male psychiatrists and psychologists, as far as my experience, better than with female ones, ESP around puberty). My son would have gone to a female psychiatrist (psychiatrist - MD) about the same time as he would have worn one of my dresses to school. Ya know, the 12th of the month after NEVER!!

    Do NOT stop seeing the current doctor, but DO get a referral to a male doctor, preferable one at a Children's Hospital.

    You can quit with the psychiatrist you currently have AFTER his first successful visit with a doctor you think you can ALL work with.

    Prescribing depakote by what seems to be OK, with-o seeing the child AND without blood tests is very risky seeming. The current prescribing info for depakote requires frequent blood work. Each person processes it differently. Some owuld be over medicated, some under and some just right.

    Also find a male therapist you and your son and husband can work with.

    Read The Explosive Child by Ross Greene if you haven't.

    What testing has your son undergone? HOW did the doctor come up with these diagnoses? When was the testing done??

    There is too much going on here. And not enough info can pass between you and your son's doctor with-o his cooperation.

    What supports does he have at school? An IEP?? A 504 plan?? Or just teachers and staff "looking out for him"? If you do not have an IEP, go to the Special Education forum and ask for help writing a letter for a complete evaluation. DO NOT hand deliver the letter. DO NOT call the request in. DO NOT mail it regular mail.

    None of these protects your son's rights.

    DO mail the letter certified, return receipt requested. THIS puts FEDERAL protections into place for your son.

    If they tell you his grades are OK and he does NOT qualify, they are not being honest. The Special Education forum will help you navigate this.

    Sending big hugs,

  9. nessa57

    nessa57 New Member

    Thank you so much for all of your comments. The good news is that he went willingly with me to the new (male) therapist today and it seems that they had an excellent first meeting. My son says he likes this guy OK and, from what he told me, it sounds like he really opened up to the guy. He was also in a much better mood after the meeting and we went home and did his homework with no fighting. So far, a good day. Keeping my fingers crossed.

    I am depending on the new therapist to provide the analysis and feedback that the psychiatrist needs for the medications. I don't know what it's like elsewhere, but around here the psychiatrists pretty much dispense medications and the therapy is done by social workers and psychologists. The new therapist we have works closely with the psychiatrist we already have.

    This did not start when he stopped taking the fluoxetine. We did wean him off the stuff and didn't stop abruptly. The moodiness, volatility, irritability, etc. got much worse after the falling out with the kids at school. I would say that was maybe 4 weeks after we completely stopped the fluoxetine.

    He is taking 500mgs of Depakote once a day at bedtime. Unfortunately, it doesn't seem to make him sleepy. On the other hand, we haven't really had any side effects from it so far. We see the psychiatrist again after Thanksgiving and I will ask her about blood tests. difficult child is needle phobic, so it is going to be very difficult to do.

    He has not had any testing done. This is something I plan to discuss with the new therapist after he gets to know my son a little better. I would like to get a neuropsychologist test done. I have been told they can take a long time to schedule.

    So far he is doing well in school and doesn't seem to need any supports there. No IEP, etc. The staff there is very aware of the issues, but so far there are no major issues.

    I am hopeful that the new therapist will put us on the right road, but I'm afraid to get too hopeful just yet. I realize that things will not get better overnight.