Obsessive Compulsive Disorder (OCD), ODD, ADHD or BiPolar?! What medications?

[WTF]

I have never been to a forum before, but as my username suggests, I am at a complete loss as what to do!
My son has always been Obsessive Compulsive Disorder (OCD), been athletic, and did great in school. After he hit teen years and has gone through some bad experiences, he has gotten totally apathetic. Recently, he started becoming defiant and eventually aggressive and hostile.

He was diagnosed with Depression, Obsessive Compulsive Disorder (OCD) and ADHD. The Dr. prescribed Prozac which made him wildly erratic and mean. He was then diagnosed with BiPolar. They now prescribe Seorquel, which I am afraid to give him until I hear from other parents.

Though apathetic for the last 2-3 years, in the last 6 months, he does not care about ANYTHING, including any consequences. He gets A's in school, if he goes. He runs away all the time. He started smoking pot (says its the ONLY time he is happy and he doesn't care if its illegal because everyone is just stupid), occassionally drinks alcohol, has taken other kids Albuterol and recently started taking huge doses of cold medicine. He throws and breaks things when he doesn't get his way and fights "below the belt". He was never "mean" before, but has always been resistent to change, stubborn, and digs his heels in.

He genuinely seems remorseful when he runs away or gets bad grades. He turned F's and zero's into C's, in a week and a half. But when I found drugs on him and grounded him, it started all over again and he ran away.

My concern is the diagnosis and getting him on the right drugs. Obsessive Compulsive Disorder (OCD), ODD and Depression are resolved with SSRI's, but that made him worse. ADHD medications can trigger Bipolar reaction, but we haven't tried them. THe BiPolar medications scare me to death. My gut tells me its totally Obsessive Compulsive Disorder (OCD) behavior, and then anger and remorse for not being perfect...(along with some teen manipulation and defiance) but if SSRI's don't work, what then?

 

[InsaneCdn]

One layer at a time? We had to do that.
I'm just a parent... of a complex difficult child with a string of dxes, built over time.

Treating depression with medications is sometimes helpful... but not if medications are the only treatment. And especially not if the depression is secondary - i.e. the result of other issues in his life. been there done that... you have to get to the bottom of "why", somehow.

ODD? skip it. You already know he has behavior problems. The diagnosis doesn't tell you any more than that - no interventions, accommodations or medications.

Obsessive Compulsive Disorder (OCD)? Often, it's a form of anxiety, which is another mood disorder. If secondary depression exists, we've been told that secondary anxiety is also often present. difficult child just missed an Obsessive Compulsive Disorder (OCD) diagnosis by a hair - we started finding answers, and the behaviour changed enough that they couldn't pin it, but.. we know it used to be there.

Can't comment on bi-polar - haven't gone that road.

Now for the intersting part.
ADHD. Not an uncommon diagnosis. In fact... runs in the family around here - for multiple generations.
Should be simple, right?
NOT.

There's two problems with ADHD as a diagnosis. Doesn't make it an invalid diagnosis, just... be aware.
1) It is often given "instead of" more pervasive dxes, such as Aspergers or Autism Spectrum Disorders (ASD). If the person doing the evaluation is more familiar with ADHD, and not with the pervasive dev. disorders, it definitely skews the results. So... this may not be ADHD at all, it may be something else. (I have heard others say they started with ADHD and ended up at bi-polar... there's probably other mixes too)
2) ADHD can stand alone - a person can be ADHD inattentive type and absolutely nothing else (I've got one of those). But... more often, ADHD comes with multiple additional co-morbid dxes, including:
- LDs (learning disabilities)
- Developmental Coordination Disorder (DCD) (developmental coordination disorder, a motor skills problem)
- APDs
- secondary mood disorders

Has he ever had a comprehensive evalutation?

 

[BusynMember]

Hi there and welcome to the board. Sorry you have to be here though.

As I was reading your post, the first thing that popped into my head was "pot" which can make one VERY apathetic. Then I read he was also drinking and using other drugs and I think your son has changed so much due to drug use. We had this with my daughter too. She was also diagnosed bipolar, and put on medications and we believed she had bipolar, but now that she is clean, she really does not have symptoms of bipolar. medications, wrongfully used, will really mess with a teen's head and attitude and mood. Seroquel will not help him if he is going to continue using recreational drugs and drinking. The other stuff will just mess up what the prescribed drugs are supposed to do, even if he really is bipolar (and I'd want him to be clean first to see if he is bipolar or just uber-moody due to the drug/alcohol use).

in my opinion I would address the drug issue first because as long as he uses, nothing else will help him, including prescription drugs. If he was depressed before he started smoking pot, and that is one reason he decided to smoke it, it isn't going to get any better until he stops...ditto for the drinking and OTC drug use. In fact, alcohol is a depressant...it can become a vicious cycle.

Unfortunately, drug use is probably the biggest reason that a teen suddenly changes for the worst. Have you thought of getting him involved in some sort of drug program, either outpatient or inpatient?

This is a very difficult problem and I'm so sorry you are going through it. I offer my sincere empathy as one who saw her daughter go down the tubes due to drugs. Please try to get your son help for this ASAP and keep us posted. We care. Can you tell us more of how he was as an infant/child? When you say he has Obsessive Compulsive Disorder (OCD), what does he do? My oldest son has Obsessive Compulsive Disorder (OCD) and he used to count the words people said. It got so bad that he had to quit college. He also had obsessive thoughts that scared him.

I still think the drug use is your #1 problem for now. He is probably using more drugs than you know, at least, that's how it usually goes...

Hugs!!!

 

[TerryJ2]

Welcome, wtf.

I am so sorry about your son. First of all, you have to get him off of the drugs. Do whatever you have to do; in our case, I had to drive our difficult child everywhere and monitor his every move, totally strip his room and even yell at his druggie pals on the phone. In the end, it culminated in my calling the cops on my own son. Best thing I've ever done.
You need random drug screening. If you can get your son to cooperate, do it at home. You have to stand in the bathroom with-him, by the way.
If he won't, you have to get someone else involved.

Also, Prozac is not a good drug for bipolar. It can be used carefully, along with-other medications, but if he is truly bipolar, then you need lithium or something else in that family, and an antianxiety medication.

Was he always ADHD, even as a tiny kid? I need to know how much of this was caused by the street drugs and how much is genetic. He is self medicating because he's got underlying problems; that's my armchair quarterback comment for the day.

 

[AnnieO]

Welcome. I wish you hadn't had to look for us, but let me tell you, this board has saved my sanity more than once!

OK. The drugs are the first thing to tackle. Pot - yes, apathy - mellows a person out so they don't care. Cold medications - UGH, BAD NEWS. Onyxx did "Triple Cs" as she called them (from Coricidin Cough & Cold. There are other names; in the 80s it was called Robotripping (from Robitussin). Any medication containing dextromethorphan will give the same high, and in smaller doses (usually the recommended) it can make a person sleepy (but the sleep isn't that great, similar to alcohol). Larger doses can make a person jittery or hallucinate (or other effects) - and can push their heart rate through the roof. They're just as dangerous as many Rx drugs.

Once drugs - and the residual cravings - are addressed, you may find there isn't really any other diagnosis. Or like Onyxx, he might be bipolar and self-medicating. Prozac is disastrous for bipolar as are many other antidepressants. An antipsychotic or mood stabilizer might be a better bet. Risperidone worked for Onyxx - and Invega is a miracle for her - Seroquel did at first and then not so much, but for others it works wonders. Really, it depends on the person's individual body/brain chemistry. Also... They won't have the intended effect while he is on drugs.

More - it is a long road, but our kids are worth the attempt!

 

[buddy]

Hi ...just wanted to welcome you. I'm with the others. No way to get an appropriate diagnosis until he is off drugs. They are rarely only using what they tell you. We have a lot of this in my family and it's a hard thing to accept. Several of my family have complications of adhd (so impulsive and poor judgement etc) or bipolar ( so more self medicating and wilder mood swings etc.) But until off the drugs, no way to know totally. He needs treatment and intensive supervision. Terry totally gets it, she and others here will have great ideas.

Hugs.....you're not alone!

 

[Amelia G]

My two cents:
Don't freak out about the bipolar medications, atypical "antipsychotics.:" They're just a class of drugs that effect the neurotransmitters more in one direction (dopamine, I beleive) than another, just like most psychotropic medications are. My son was just put on Seroquel as he was diagnosed with bipolar. It was a little sedating at first, but not really any more for him. He has more focus now. He has ADHD from drug-positive birth onwards, so he still needs at least some stimulant to keep him on track. It's interesting to me notice the similarities and differences between our kids. Mine just got into major trouble because of running away, and he's only 8. He has Reactive Attachment Disorder (RAD), PTSD, ADHD, ODD, and now bipolar. He has rages. When in the hospital recently, they took him off all his old medications and put him on new ones. In the meantime, we saw many changes... He is totally out of control with no medications. They put him on seroquel and that made him calm, but still not focused. They added a stimulant back in for the ADHD and that helped a lot, even though it is a smaller dose than he used to have. Then, he began showing true classic Obsessive Compulsive Disorder (OCD) behavior. Before, he had shown some Obsessive Compulsive Disorder (OCD) tendencies, but not clear enough to label. Now it was clear. So they added back a SSRI in a baby-sized dose. The new mixture produces a totally different kid, but is working as far as I can tell. His medication mix isn't settled yet. My real message is to not let the antipsychotics freak you out. I had that reaction initially, too. Earlier, my son had been put on Abilify and it made a HUGE positive difference. My own psychiatrist has me on a baby dose of Risperidone, and it does seem to do what is meant to: mood stabilization. Things get so much more complicated after puberty, and chemistry can change. My recommendation is to try what the psychiatrist says, and see if it helps. In the end, all we have is trial and error.

 

[WTF]

First, THANK YOU ALL SO MUCH.
I didn't have a chance to get back on yesterday/last night. My son got in trouble at school yesterday for having the 3C's (cold,cough stuff) and suspended for 5 days. When I tried to ground him and take his phone, he went on a rampage and knocked me to the floor. I'm a single mom and know that I raised my son better than this, but he's so irrational and erratic, he can't see straight and do right.

His friend came over and helped me calm him down, and we got him to take the Seroquel. I guess last night was my breaking point and I will try anything right now.
My eyes are sore from crying all night.
For those of you who have experienced these outbursts and drugs, I want to ask... what kind of treatment do you suggest? In-patient/ outpatient? Rehab?

To answer some questions that might help... He has always been Obsessive Compulsive Disorder (OCD). When he was 2, he would arrange everything in his room in line by color and size, and freak out if friends came over and messed with his "arrangement"... the toys. He gets very frustrated at any change and I think one of the biggest problems with his Obsessive Compulsive Disorder (OCD) is that he won't turn in homework or he skips tests because its not perfect, so ironically, despite doing good school work, he gets zero's.

The anger outbursts did not start until we put him on Prozac for depression and anxiety... BUT this also coincided with extreme pot smoking (he didnt get high, he would get wasted). To be honest, he was nice when hes high.

Ughhh. I don't know what Im doing. I just dont know what to do next. Wait and see if seroquel works?

 

[buddy]

How is he socially? Has he had friends all of his life? My son lines things up, has to have whole sets of things etc....and I have had several students who line up things, pair things, things have to face a certain way etc.....they all were on the autism spectrum.

Has he ever had a full day/2day comprehensive evaluation like a neuropsychologist setting? Just curious in case its an option that could offer new therapy ideas....

 

[BusynMember]

Sounds like he could be on the autism spectrum and the drugs may be a way of his coping with it. I'd have him evaluated by a neuropsychologist, but he still needs to quit using drugs before you can really help him.

 

[TerryJ2]

I'm with-MWM. Lining up things and being obsessed with-one topic sounds like autism, and the drugs are self medication.

Once the prescribed drugs get into his system he will be more calm.

Has he been held back in school? Is he on grade level?

When my son was little, he ruined some really nice books of mine, and CDs, especially in the car. So I carried phonebooks in the car, and left extras in his room so he could shred them when he was uptight and ready to rage.

Is he apologetic after he rages? Did he apologize for knocking you over? If he is on the spectrum, he still has to apologize and make it up to you. Having Asperger's or bipolar, for example, is a diagnosis, not an excuse.

I am sorry you cried all night. I know the feeling.
My son hates it when I cry and he will even offer to bring me an ice pack and give me a neck massage. Of course, once things are calm, then it starts all over again ...