Puberty--effect on previously stable medications?

Discussion in 'General Parenting' started by pepperidge, Nov 7, 2008.

  1. pepperidge

    pepperidge New Member

    Yikes! What's a normal 14 year old boy, anyway? Can't tell what's puberty and what's the mood disorder. And I have no experience with normal boy development, if there is such a thing. I need a few arm-chair psychiatrists here so I'm calling up you guys whose collective wisdom is always appreciated.

    My soon to be 14 year old has had a great year or more of stability. He's on Lamictal for depression, low dose of Risperdal (helps anxiety, irritability) and a low dose of Adderall (seems to kick in frontal lobe and help him behave more age appropriately.

    But in the last few weeks, he has gotten much more depressed/irritable, and in the past two weeks or so, anything you say negtive or no results in door slamming, my life stinks, I might as well be dead, etc. While I don't think he is an immediate suicidal risk, these constant statements have me worried and I am constantly checking on him. He hasn't raged in a few years, but just the other night he threw a vase at his brother who was getting on his nerves and managed to shatter the glass on the oven door. Feel most of the time like I am living with a young adolescent girl. He started off the school year great, then got a cold, and it seemed to go downhill from end of Sept.

    Right now he is complaining of an intermittent bad stomach ache--thought it was a flu bug, but he doesn't have any nausea, diarrhea, etc. It is more in his stomach area than abdomen. It has gone on for a few days so I guess a doctor visit is in order. I wonder if the physical symptoms are increasing his irritability, or whether the upswing in depression etc is somehow contributing to stomach stress. Never had this before. Going to be hard to a regular doctor to sort it out, I would think.

    WE are between psychiatrists right now, which stinks. The one we had moved away a few weeks ago (2 day drive away). We made an appointment with a new one, but the appointment isn't til right before Thanksgiving. Don't have an appointment for two weeks.

    We successfully weaned him off of Topamax this summer because we were concerned about possible cognitive impacts and slightly upped the Lamictal. We didn't know if the Topamax was doing anything, so we went through about 4 months of going down from 100 mg to nothing. Didn't notice very much of anything, though we did up his Lamictal by 25 mg at some point. We just upped it again by 25 mg a few weeks ago as he seemed to be more depressed, stopped trying in school etc. I can't believe that that would contribute to stomach problems. I am thinking that we may need to up it again. Or maybe it should be lowered--could the return of the irritability etc be a signal that we are up too high? Somehow, I don't think so.

    I've heard of medicines stopping working, but this seems like a pretty sudden deterioration. psychiatrist we are going to see doesn't get glowing recommendations, but thinking that we were mostly talking about renewing prescriptions I wasn't overly concerned. But this has me worried, and next closest psychiatrists are at 3 hours away, and if not there, probably in Seattle or San Francisco.

    Appreciate, as always, any insights into boys, medicines, depression or whatever.

    Last edited: Nov 8, 2008
  2. Marguerite

    Marguerite Active Member

    We're dealing with ADHD medications, but we found that two things have cut back on medication effectiveness:

    1) the growth spurt from puberty maybe doing things to metabolic rate and other body processes; and

    2) the growth itself, meaning he weighs more and the same amount of drug has a bigger body to treat.

    Whether hormones have other effects as well - not sure, other than growth effects on metabolism already mentioned.

    But yes - I hear it often and saw it with our kids. In fact, we've had to increase difficult child 3's medications TWICE in the last four months, because of his rapid growth and puberty. The change in him can creep in slowly, or it can seem almost overnight.

    It can be rough. Good luck with the new doctor.

  3. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Just a thought on the Lamictal and stomach problems, in this case looking at the low dose he's on I doubt it's affecting his stomach but when my difficult child went from 500 to 600 mgs he started actually getting nauseated and vomiting. We have to now give part of his dosage at night and part in the morning.

    It is so hard to tell what is puberty and what is the mood disorder. I wish I had some advice to offer and I hope the time between now and when you see the new psychiatrist goes quickly. If it continues to spiral I think I would try calling and explaining and see if they could get you in earlier.
  4. crazymama30

    crazymama30 Active Member

    Call your psychiatrist, explain what's going on and see if you can get in sooner. Maybe he has some cancellations, or at least one could hope.

    I know many people I know complain of stomach problems when they are stressed. Do the holidays bother him? Could he be bothered by going to a new psychiatrist? Is he in a different school this year? I know I dread next year when difficult child gets to go to a new school, that will probably really set him off.
  5. smallworld

    smallworld Moderator

    How much total Lamictal is your difficult child taking now?

    Sharon is right -- the stomachache could be from the Lamictal (it's a known side effect). Or it could be from depression itself (my daughter gets headaches and stomachaches as a symptom of her depression). But you do need to rule out physical causes before settling on psychological. I absolutely recommend a visit to the pediatrician ASAP.

    I know she's not a boy, but my daughter is just starting puberty, and she was on 125 mg Lamictal until last spring when we started to see break-through mood episodes. We raised her Lamictal dose by 50 mg then, and her mood smoothed out. This fall again we saw irritability and school refusal creeping in and raised her Lamictal dose another 25 mg so she's now on 200 mg Lamictal (broken into even morning and evening doses). She is stable again with this medication increase. From what her psychiatrist said, I think this kind of medication adjustment is very common in puberty. I wouldn't be surprised if we'll have to make more medication adjustments as she continues to grow and change.

    FWIW, at age 14, my son's depression was so significant that he ended up in a day treatment program for 6 weeks. He was already on 400 mg Lamictal so both Zonegran and Seroquel, which help with depression, were added. He has been stable since he left day treatment in January, and we've even been able to lower his Zonegran and Seroquel doses. But he has stayed at 400 mg Lamictal throughout (this is the top level his neuro and psychiatrist felt comfortable with).

    It really stinks that you're between psychiatrists and the new one doesn't get glowing recommendations. However, is there any way you could call new psychiatrist's office Monday to see if you can get in sooner? You never know if there have been cancellations since you make your original appointment.

    C, I'm sorry you're struggling. Hugs.
  6. Fran

    Fran Former desparate mom

    Our experience with that the whole 11 to 15yrs old in difficult child was a medication nightmare. Up until that time he had only been on ritalin. He had medication adjustments every couple of months and was hospitalized because his iirritability moved to total meltdowns. Puberty was like throwing gasoline on an open flame. I would never go back to that time in our families life.

    Your difficult child doesn't sound quite as severe but I can understand your concern. I would call the pdr. that knows him and ask advice. He knows your son and the medications.
  7. susiestar

    susiestar Roll With It

    I am so sorry you are going through all of this (and that HE is having to cope with it too!). Puberty sets everything off. We had to do a LOT of medication tweaking, and it still never got wonderful until he grew out of it.

    I did find that when Wiz was reminding me of a PMSing girl with certain mood swings, I would give hiim a few pieces of Dove Dark Chocolate and they helped smooth the worst of hte edge off. It wasn't an everyday thing, but once in a while he just reminded me of that "every single time the air shifts it gets on my last nerve and I just want to scream " PMS I used to have. It was worth a try, and it sometimes worked.

    Puberty is really a rough time.
  8. klmno

    klmno Active Member

    Hi! I just wanted to let you know that I understoand and we go through this, too. The way I look at it is that although all young teens will have their normal mood swings, these do more of a number on our difficult child's, particualrly if depression or mood cycling is one of their issues. I would take the signs of depression seriously since most difficult child's aren't that good at reeling themselves back in from these moods. As far as medications, difficult child's psychiatrist says that as weight is gained, or a growth spurt happens (taller but not necessarily weighing more), hormones change, etc., the medications usually need to be adjusted. My son is on lithium and depakote so he'll get a blood draw when he seems out of kelter.
  9. pepperidge

    pepperidge New Member

    Thanks for your replies. I guess puberty can really play havoc with teh medications. That's what the psychiatrist has been telling me, but we had such stability (for a whole year!) I didn't really believe her I guess.

    In any event, took son to pediatrician this morning. He thinks he has gastritis, maybe ulcer. He put him on a course of prevacid, with instructions to call back towards the end of the week if things aren't improving. Poor kid he has bad pain that wakes him up in the night
    and he has trouble going back to sleep. He's been up for several hours each night. I haven't been to bed before 2 or so in the morning for the last two mornings. He just went to sleep, but I think if he wakes up in pain and can't get back to sleep I am going to call pedi tomorrow morning and see if there isn't something I can't give him at night that would help him sleep.

    I figure some of you out there must have experience with gastritis/ulcers. Any advice? Am trying to get him to eat small meals a lot. He has allergies to milk protein, so we try to limit that as much as possible. He's kind of a meat and pasta guy, soup, chocolate (loved the comment about dove chocolate!), rice, so I am trying to find somethings that he likes.

    Of course, all the lack of sleep really exacerbates whatever depression is there. Since I just increased the Lamictal by 25 mg a couple of weeks ago, I think it may be best to give it another week or two and see what he is like once his stomach clears up and he is sleeping better. I'll see if we can't get into the psychiatrist earlier, too, but I almost would prefer to wait a week or so to see how much is just being sick.

    He is generally anxious, but it has been pretty well controlled. We don't push hard on school--no homework at home. I wonder if all the anxiety in general could contribute to the gastritis. One of those things I wonder if they have really done any research on.

    Anyway, thanks for listening. I have been splitting his Lamictal and Risperdal dosages in half, so will continute that.

    If we survive puberty it will be a miracle. My soon to be 12 year is as advanced as my soon to be 14 year old. Will do anything to get friends. I'm petrified, but that's another post.
  10. pepperidge

    pepperidge New Member

    Can't figure out how to change the title of the thread to show update. Can anyone help? thanks.
  11. Marguerite

    Marguerite Active Member

    On the subject of ulcer - thinking has changed in recent years. I remember years ago when you were diagnosed with an ulcer, it was blamed on bad diet and stress and you were put on a diet of antacids, chalky stuff and nothing spicy. It took ages to treat and never really seemd to go away. It could be really nasty.

    Then an Aussie researcher (yay!) who has since won the Nobel prize for it, discovered that it's caused by a bacterial infection, Helicobacter pylori. It used to be called Campylobacter until about 10 years ago.

    So don't get caught up in old-fashioned myths now overturned and don't stress about it too much - this responds to specific antibiotics.

    It's also much easier to diagnose - instead of needing endoscopy and biopsy, a breath test can detect active Helicobacter infection. difficult child 3 had that to rule it out. However, endoscopy can be indicated if there are other things in there that the doctor wants to look at.

    Giving difficult child pills and saying, "come back in a week and report," is a good way of quickly, cheaply testing for this.

    There are still other possibilities that I'm sure this doctor is considering. Also, do not discount the extreme physical symptoms you can get, purely from extreme emotional stress. difficult child 3 still has difficulty accepting that his anxiety alone can cause such extreme symptoms in himself.

    Also, easy child 2/difficult child 2 has symptoms of abdominal pain and nausea (especially after eating, even just drinking water, or soup) and it continued after EVERY meal. The doctor has finally diagnosed over-sensitive stomach nerves (especially stretch receptors)which are sending messages of pain when they should only be recording "hey, something's here." In her case it LOOKS like anxiety but it has a physical cause. The treatment in her case is an older form of antidepressant which works to sedate the stomach nerves.

    She's also been told to modify her diet - to cut back on fat, to eat small meals often.

    I hope you get some good answers soon.

  12. crazymama30

    crazymama30 Active Member

    I would think that a soft bland easy to digest diet would be good. Nothing too spicy, ulcers aren't caused by food as Marge said, but foods can irritate them. Pasta would be good, but watch the sauce. Potatoes are bland, If you could somehow modify mac and cheese that may be ok. Google ulcer diets, or something similiar. Googling is great.
  13. smallworld

    smallworld Moderator

    My father is a GI doctor so I know a fair amount about this stuff.

    Campylobacter is a food-borne bacteria that causes GI upset (notably bloody diarrhea). H pylori is one bacteria that can cause ulcers, but my father is not all that keen on the accuracy of the breath test to diagnosis it (high percentage of false negatives).

    Not long ago, the common belief was that peptic ulcers were a result of lifestyle. Doctors now know that a bacterial infection or some medications — not stress or diet — cause most ulcers of the stomach and upper part of the small intestine (duodenum). Esophageal ulcers also may occur and are typically associated with the reflux of stomach acid.

    Prevacid treats esophageal reflux by neutralizing stomach acid and will also help an esophageal ulcer heal (because stomach acid will no longer be washing over and irritating the ulcerated esophageal lining). Prevacid does not treat a peptic ulcer. Unfortunately, it might take a while longer than a week of Prevacid to see real progress if an esophageal ulcer is present. Discomfort from reflux typically does respond to Prevacid relatively quickly.

    Chocolate, by the way, makes reflux worse. So do spicy and acid-based foods like tomatoes and citrus fruits. I myself have reflux so I know this is true for me!

    If your difficult child's stomach discomfort persists, I would recommend seeking an opinion from a pediatrician GI doctor and considering an endoscopy to make sure you know what you're dealing with. When my girls were experiencing significant GI discomfort, they were scoped. I'm not saying this is the case with your difficult child, but it turned out their GI complaints were related to anxiety and mood instability. When we treated their mood issues, the GI complaints went away.

    Hope you get some answers soon. Thinking of you.
  14. totoro

    totoro Mom? What's a GFG?

    Ahhh hormones! Gotta love em'. Right?
    Well I do have a funny take on it, Our psychiatrist here who has a BiPolar (BP) kid. Told husband who gets wooozy at the thought of puberty!
    Well he kept telling her that our girls are going to be early, because they have been like little replica's of me, I started at 9!!!
    Our psychiatrist laughed and said, "Well considering how much h-ell you have been through and how crazy your kid already is, how much worse can hormones honestly make her?"
    We all started laughing in the room. She said this tongue in cheek of course, but was a bit serious and said that some of our kids once the hormones do mellow out, we find we actually have a nicer kid, because they are not cycling so often.
    They have found their Bipolar groove so to speak.

    Sorry about his tummy, Lamictal messes with my stomach. Especially when I am titrating up.
  15. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    With mood/anxiety disorders often you also have stomach disorders. I had gastritis and colitis. Both were nasty. Some were medication related. One medication I took caused gastritis all by itself and it cleared up as soon as I changed medications.
    Has your son been on all these medications for a long time? We found that Adderrall, even in a small dose, made my son mean and aggressive. If it's relatively new, I'd look at it. From somebody who has taken a lot of medications myself, I know first hand that any change of medication, even dose, can cause a negative reaction as easily as a positive reaction. I do know that, as a child with serious mood issues and anxiety, it all came out in a blast when I turned thirteen. I was never the same after that--the mood disorder had bust out in all it's glory. Course in those days there were no medications--you may also be on the lookout for recreational drug use. That can change everything. Any change in friends? Any really unusual behaviors? Kids with mood disorders are far more likely to abuse drugs than kids who don't have them.
    Good luck.
  16. pepperidge

    pepperidge New Member

    Thanks for the info, Smallworld and Marg. He has been on medicines for a long time--Adderall for at least 4 years, with great results, but needs mood stabilizer as well. So don't think it is medications that are causing behaviors. Am chalking it up to pain, lack of sleep, and as so many of you have pointed out, the glories of puberty which will probably mean we need to tweak things soon.

    I called up the doctor this morning and told him about my son being up for 5 hours last night in pain (as he has been the the two nights before that). Prevacid didn't seem to help, thought maybe a wonder miracle cure is too much to hope for.

    The nurse reported back to me after talking to doctor. He prescribed Sucralfate (medicine that coats the stomach to be taken close to right before bed) in addition to Prevacid. So we will try that tonight. Will also give him some Tums. That just about covers the waterfront, so to speak.

    The nurse reported back that the doctor also said he could take Motrin for pain. I questioned her about that--I thought that was the last thing you want to give if there are potential stomach issues. Makes me wonder about the pediatrician.

    Also, I had him eat something (applesauce) in the middle of the night last night thinking it would coat the stomach, but that might have made it worse. I am desperate for him to get some relief tonight, because we both need a good night's sleep after being up most of the last three nights.

    Mood was better today. Perhaps the pain was less. I also started ten minutes on what I call the grow light. I know his has major seasonal issues, so perhaps this will bring some improvement. But am going very cautious with the time. psychiatrist several years back said to try it, but I think it was before we got stabilized on Lamictal so I don't think it had much effect back then.

    Am wondering if teenage overindulgence in Halloween candy could have singnificantly exacerbated this.

    Also have read that some of this stuff has strong familial roots--don't know enough about birth parent medical history to know if that is an issue.

    Anyway, that if nothing else made me resolve to see a gi doctor this week if things don't dramatically improve. Don't think we have a pediatric one in town, but seeing as he is just about 14 hopefully the adult ones will see him.

    Cross your fingers--we need to sleep here tonight!!!
  17. smallworld

    smallworld Moderator

    Motrin can definitely make reflux and esophageal ulcers worse. My docs tell me to stay away from it (but I do take it for migraines at times).

    Propping him up in a semi-reclining position with pillows might help him sleep. Applesauce has some acid in it so that could make things worse. My father always recommends warm milk. Can your difficult child have rice or soy milk?

    Hope you get some rest tonight.