psychiatrist just added an AD

Discussion in 'General Parenting' started by klmno, Nov 24, 2008.

  1. klmno

    klmno Active Member

    psychiatrist added the generic of Cylexa. After 4 days, difficult child will be taking 20 mg/day of it. Does anyone have experience with this? He also raised difficult child's low dose of depakote er to 750 mg/day and kept the lithobid at 1200 mg/day.

    We will be leaving soon to go sit at the dr's office to get difficult child checked out for the physical symptoms...
  2. crazymama30

    crazymama30 Active Member

    All I can say is I am sending good thoughts your way. I hope it helps, and hope things look up for you both soon. No experience with ADs here
  3. ML

    ML Guest

    Today it's my turn to make that call "take him in or wait". Manster has a sore throat and viral symptoms which could be anything including strep. Of course with the sensory sensitivities combined with school anxiety the performance this morning got to me. So I will make an apt. just because he is traveling by airplane tomorrow and I want to rule out the worst. I just got a letter from the SD staying he's had too many tardies and absenses, more focus on the tardies so hopefully we're still in their good graces.

    Manster is weening off the Celexa. Your situation is different because you're augmenting an existing protocol. It truly did help with the anxiety. Wish you best of luck.


  4. klmno

    klmno Active Member

    Thanks, crazymomma and ML!

    ML- It sounds like we (and our difficult child's) have some things in common- at least this school year. I thought psychiatrist told me cylexa was an anti-depressant. But, difficult child could use a little help with both depression and anxiety, I think.
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi there. I wish you luck. That was a bad choice for my teen daughter. It made her overly nervous and manicky and she stopped taking it. Watch her and see. It's always hit or miss.
  6. bran155

    bran155 Guest

    I don't have any experience with this but I just wanted to say good luck. :)
  7. smallworld

    smallworld Moderator

    Personal opinion from many medication changes with my kids over the last 3 years: I'd make one change at a time (first Depakote increase, then Celexa introduction) and go slower on the Celexa titration so you don't knock your difficult child into mania. There is never any reason to go quickly unless you're in a crisis situation.

    FWIW, my daughter A takes Lexapro (related to Celexa) with good results. But we keep her on a low dose with her Lamictal so she doesn't go over the top. All SSRI antidepressants like Celexa help with anxiety and depression.
  8. klmno

    klmno Active Member

    I think psychiatrist raised the depakote because it had been below theraputic range and to try to ward off potential mania from the celexa. Basicly, the depakote would have been raised a few months ago to keep up with difficult child's growth/weight gain, but I didn't want to due to cognitive dulling. The blood test came back real low for depakote. I'm comfortable that the depakote increase would not have helped with depression- at least, it didn't last year. It has been what helped with cycling into hypomania in the past. I'll keep an eye out, but I think this one will be ok.

    psychiatrist also mentioned lamps since difficult child's cycling is so related to seasons- I'm thinking difficult child is on the line for a SAD (I think is what it is called) diagnosis. Anyway, psychiatrist also mentioned the risk of using a lamp with BiPolar (BP) and said he didn't really think it would be worth it to try.

    As far as the dr, he said difficult child's allergies are out of control. (difficult child has been refusing to use his nasal spray). So, the dr said this is causing disruptive sleep, headaches, fever, earache, and sore throat. I believe that- when I started taking a scripted allergy medication daily, I slept better and felt better after one week. I felt like a new person. The dr I had seen before had wanted to put me on AD's for telling them the exact same thing. I didn't take the AD's because I didn't believe it was depression.

    Now, my biggest concern is what if this whole phase of difficult child's cycling was really started by untreated allergies and he shouldn't have the AD added? Ok, thinking more, even if that's what started the cycling, I kind of doubt that getting the allergies under control would necessarily mean that the cycling would stop, but I don't know. I'm a little tempted to make sure difficult child uses the nasal spray and not make any changes to BiPolar (BP) medications or use the AD until after one week. But then, that's risky too since the cycling can get worse and go into full blown mania at a second's notice.

    We see psychiatrist again in 3 weeks- I'll discuss it with him then.
  9. MyFriendKita

    MyFriendKita Member

    This is just my opinion, and I am in no way, shape, or form a medical professional, but I would be extremely leery of giving an AD to any bipolar child, but especially to one who is already in legal trouble. I did face this with my own son when he was a couple of years older than your son (he was 16). I thought the psychiatrist was going to rx an AD (my son was originally diagnosis ADD/ODD, then after psychiatric testing he got a diagnosis of dysthymia/ODD). He was already on probation, and any more legal trouble would have meant severe consequences.

    At one point, I convinced myself that we should give an AD a trial, if the psychiatrist rx it, but after doing some research about manic reactions to AD's, especially among teens, I decided against it. The price for a bad reaction wasn't worth it, in my opinion. Fortunately our psychiatrist agreed, and he rx Lamictal instead, which has been a godsend for us.

    I'm not saying don't trial the AD, but I've heard a lot of stories about bad reactions to AD's (many on this board), and when a kid is already in legal trouble, I think you have to give the decision more consideration than the parent of a child who isn't dealing with the system.

    Good luck with your decision, whatever you decide. I know the position you're in isn't an easy one.
  10. klmno

    klmno Active Member

    Thanks, rm. Actually, my difficult child started on prozac as his only medication when we thought he was unipolar depression. It was an increase (doubling ) of the prozac dosage that might have put him into mania and led to his 1 1/2 hr crime spree. He was removed from medications at that point and evaluation's by his psychiatrist for 6-8 weeks, resulting in being put on mood stabilizers. He has been on mood stabilizers ever since. I had him evaluation'd by a different, well-reknowned psychiatrist after that and she felt like an AD on top of the MS's might be a good idea because she felt like my son still has depression issues. The regular psychiatrist and I were reluctant to do that and have waited a year without doing it.

    My son typically has a depressive period this time of year- this is the 4th year, so I'm ok with it, I think, right now. However, I'm not positive yet that it's the way to go year round.

    PS At least I know what to look out for this times, in terms of signs of hypomania and mania.
  11. totoro

    totoro Mom? What's a GFG?

    I did use Zoloft at one point prior to being on a MS.
    It really helped in the beginning but I think we pushed it too high. I think if I were to add one once I was stable on a MS, the *right * one it would not be so bad. Only because I suffer from bad anxiety. I would not want it as my first medication. As someone who has BiPolar (BP), but you know that.
    I did try to add on Prozac over the summer. That was not good for me.
    But I am not entirely anti AD's though.
    I agree with Smallworld though, only because we put K through hell with her past horrible psychiatrist. Pushing medications to quickly and to high and fast of a titration.

    I hope this helps him though!
    K is doing so much better now that she has adjusted to her nasal medications. It was about a week of instability but now she actually sees that it helps! Which is nice.
  12. klmno

    klmno Active Member

    Thanks, Totoro! Maybe I misunderstood- is the suggestion to raise depakote, then titrate up on celexa- or is to raise depakote and wait to see if celexa is still needed?

    From what I read online, 40mg of celexa is a typical dose. psychiatrist said add 250mg of depakote per day starting today. Start difficult child with 10 mg of celexa for 4 days then raise to 20 mg then come back and see him in 3 weeks. Do you think this is high risk for mania?
  13. smallworld

    smallworld Moderator

    I'll clarify: You need to bring the Depakote up to a therapeutic level before adding Celexa. Otherwise, you risk pushing your difficult child into mania. I'm not sure your difficult child will be at a therapeutic level within 4 days -- that seems too fast to me.

    Depakote may further depress your difficult child (because it works so well on mania). That happened with both J and A. I hate to admit it, but even on a therapeutic level of Depakote, my son became manic on an AD within 5 days.

    FWIW, some kids with BiPolar (BP) do fine on subtherapeutic levels of ADs. You may not need to go up to 20 mg Celexa because it does pose a higher risk for mania. My daughter is on a low dose of Lexapro because she was still depressed on Lamictal and needed a boost. In your shoes, I'd start at 5 mg (cut a Celexa tablet in half) and wait for a week, then go up to 10 mg and hold until you see the psychiatrist again. But our psychiatrists are very conservative and make medication changes very slowly.
  14. klmno

    klmno Active Member

    This very well might be what psychiatrist is worried about. See, the lithobid is at therapuetic range and seems to be the medication that is taking care of any mania. But, there is still a nagging thought, that I believe both psychiatrists share, that difficult child might be more of a mild case of bipolar with severe depression at times and the full-blown mania might not always really be full-blown mania- it might be more suicidal/self-destructive sort of giving up reaction.

    This would be a little easier if difficult child did what he should to take care of himself- I told him 3 weeks ago that he needed to be using his nasal spary for allergies. He wouldn't do it. I hope he is learning a lesson from this so when he's on his own someday he'll realize how quickly he can become physically ill and mentally/emotionally, things can take a drastic turn.

    I'll slow down the medication stuff until I'm more comfortable with it- first, I'll make sure he's taking care of allergies.
  15. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I know some kids with bipolar can take ADs. difficult child's psychiatrist is very hesitant to try an AD but my difficult child gets manic really easily.
    I just started on the Celexa (I don't have BiPolar (BP)) to help with some depressions/anxiety. I'm still on the 10mgs for another few days before going to 20. It's too early to tell if it's helping. I'm experiencing nausea as a side effect and it's possible the migraine I had the other day and the vomitting with it may have been related (it was my second day on it).
    The pharmacist told me it can have some strong side effects but that if I can get through them (they won't last forever) the medication should help.

    I hope the medication helps your difficult child!
  16. totoro

    totoro Mom? What's a GFG?

    This is what is so hard! What works for one of us, well maybe might not work for another.
    We just don't know, that is why I also agree that going super low and slow with doses is so smart.
    I have been titrating my Lamictal back up for so long. I am only at 150 mg and it has been months! But I learned with my Topamax that what I thought was an OK medication at one level was not OK at another.

    I had been on Topamax for years only 50mg. My Docotor thought we could raise it because of it's MS properties... I went up to 200mg I think. Pretty slow. But not slow enough and too high. I was seeing tracers, it induced mania really bad. Scary!!!
    But now back at 50mg it is great. I use it for migraines and a little bit of it's MS properties. It seems to work well for me with the Lamictal.
    So for me I am still having bad anxiety, but I do not want to add anything else until I know we are at the level we want to be at with the Lamictal.
    Because a lot of times we would add a small dose of an AD.
    Just a thought and what I am going through!
  17. susiestar

    susiestar Roll With It

    klmno, I am keeping good thoughts that you get this all figured out and adjusted with-o too many problems.

    I must say that with ANY medication that is not time released I start ANY of us at HALF of the dose the doctor suggests, and increases are done at HALF the amount in twice the time.

    So if a pill can be split, and the doctor says take 1 a day for a week, then go to 2 a day for a week, what I do is take 1/2 pill a day for a 2 weeks, then 1 pill for 2 weeks, then 1 1/2 for 2 weeks. And every increase is only done if whatever it is for is not under control.

    My body is very strange. I am hyper sensitive to a number of drugs, needing 1/4 to 1/2 of the amount other people need. But I have ALWAYS been undersensitive to some medications, needing much more than others need. Novacaine is a good example (or whatever that -caine stuff is dentists inject). I have needed as many as 4 shots for a small filling, and a crown took 12! Yes, 12 shots of junk into my mouth. AWFUL. But it took mroe to work and it wore off quicker than they could work.

    Jessie is on keppra for the epilepsy. When we do an increase we increase 1/2 pill per MONTH. I realize you do need some faster results (it took a YEAR to get her to a therapeutic range of it the first time! and it was a LONG year) but if he has had the allergy medications before, then use those and do the increase in depakote. Then, if it still seems needed, start as low as possible on the celexa, and go up very slowly. It iwll give you a better chance to stop mania if it starts to show its ugly head.

    Many hugs, the holiday season is so hard.
  18. witzend

    witzend Well-Known Member

    I loved what it did for M. He was happy and easy to get along with. For his own reasons which I will never understand, he stopped taking them. He never did as well on any other medications, and so far as I know, he hasn't been on any medications in several years.

    If your son is suffering from depression, I think that it may help him. Of course you will want to keep a close eye on him for any adverse reactions.