Question for Bipolar Adults

[Wonderful Family]

I've written this 20 different ways, and I know up-front it's a pretty impossible answer - so I'll just do my best. We're going through medication adjustments since the bipolar moods have definitely come back out again - and I don't know what's the extent of what the medications should do.

We've caught the cycling early this time; and the difference in 150 to 200mg a day of Lamictal is amazing; but it's still not as good as it was before. So, the question tomorrow that psychiatrist will be asking me is do I think it's enough; or should we adjust the medications more. Which one - Geodon or Lamictal?

What I don't know is how much more the medications should be adjusted or how much it can actually do? Can they do more than just stop the explosions and raging? Can you describe what to look for or what you saw/see?

Even "stable and doing well", difficult child appears to work so very, very hard at everything. Sometimes it seems like it's just too hard and I'm missing something; but I don't understand how to describe it or even what to expect.

Any insights would be greatly appreciated.

 

[TerryJ2]

I have no answers, just wanted to lend support.

 

[DammitJanet]

What do you see him working hard at? I think that would kind of be a lead in my answer. If he is really trying to hold in his anger...maybe that is the geodon. If it is more on the impulse/cycling/moods...it could be upping the lamictal another 50 mgs might make a difference.

I know how hard it is to try and tease out which medication needs to be adjusted. I am doing that now.

 

[Wonderful Family]

difficult child works hard at maintaing his anger and getting himself back under control. He is very compliant with medications; and has even started taking them at dinner time vs. later in the evening to help him fall asleep earlier since the moods started.

difficult child can stop, backaway and get himself under control, but then anything can set him right off again. Several weeks ago, he would have been able to not get so angry immediately, wasn't nearly as irritable (all the time), and would not go right back to getting upset again right away. He is also either extremely hyper or he is shutting down for periods of time (minutes - not hours). He can't respond at all during that time that he shuts down - happens multiple times a day. Then it's like a light goes back on and he's ok for a period of time and then we start all over again. Every noise and thing that happens drives him crazy. We can see where things have gotten more difficult for him week by week over the last 6+ weeks.

difficult child is also trying to get along with others such as trying to play with his brother right after he gets upset and then calms himself down (kind of like - see Mom, I'm fine) - but things get out of hand immediately; he tries to play a game with me and can only stand to do so for a few minutes when normally he can do 15 or 20 minutes at a stretch.

 

[Nomad]

Our difficult child never had luck with Geodon. In fact, it caused many problems with- depression. However, her doctor tells me that others did very well with it. Lamictal has been a very good medication for her. I have heard a lot of positives about it. Again, it's hard to say...folks are individuals.
Generally, I can tell you that Lamictal, therapy and time has made a huge dent with reference to raging and this is a blessing. She also takes Seroquel for sleep and I do believe this helps a little with raging as well. Abilify has been a helpful medication and might be one to ask the Dr. about. Generally, Lamictal and Abilify were used to stop raging and Serqouel for sleep...but may have had some input to stop raging as well. I recall well how much damage the raging brought to difficult child and our family. difficult child was always so over sensitive; particularly at school. She would have explosive reactions when other children would be sarcastic, etc. Sometimes, there didn't seem to be any logic to her reasoning or reactions at all. At home, she was usually better...happier. There are now other concerns causing issues unrelated to raging....but the raging was a "biggie" that is significantly better.

 

[lovemysons]

Hi wonderful family,

I tried the Geodon for awhile...a month exactly and it made No Difference. I was still a very frustrated, Manicky, Person.

I love being on Abilify...takes the "fight" right out of me, no frustration or extreme anger/emotion like I used to have.
Have you tried Abilify for your son. I am only on 5mgs and it works wonders!

Hope things improve,
Tammy

 

[totoro]

I know I am late to this.. of course!
Geodon did not help K much.
For her about 200mg of Lamictal was pretty good, I think we could have snuck it up a bit.
Also Abilify was very good for her.
The only reason we stopped these was due to no psychiatrist! YIKES
She is now titrating off of her Seroquel due to incredible weight gain and titrating back up on Abilify.
We will most likely add the Lamictal again once the Abilify is at target range.
I really like to make sure I get the full affect of each medication before adding another.
Personally.
For me I love Lamictal. I am at 200mg. When I start getting wonky, which would be racy, or extra up... without much coming down in between or not sleeping a lot. Which for me is more than 2 or 3 nights of not much sleep at this point then I look at my medications.
I am also on Topamax and Trazadone and Xanax.
So I know I am at target dose with Topamax. How? Because I have upped it to a high dose, 400mg and I hallucinated and got manic. So I backed down and was fine!
Trazadone I have room to play with also. I am keeping it at the levels I am at until I start losing sleep more a than 2 nights or so. Or if I get depressed.
Xanax is a PRN for stressful situations or bad anxiety.

So for me I am very aware of what each medication is for and how it targets me. I try hard to get them up to target dose or as close as possible.
I have found this works best with K and myself.

Like for example with K, I know is having an increase in anxiety,increase saliva, some internal agitation... these are from Abilify. So I will watch this and see if it calms once she is at her target dose, before we add her Lamictal.

I hope today went well! it is very hard to figure out. I would try to keep track of the moods, when why, situations, stresses etc...

 

[Wonderful Family]

difficult child just gave me the best gift ever by being a true difficult child with the psychiatrist; psychiatrist surprised me a bit and suggested Residential Treatment Center (RTC) again or perhaps a therapeutic summer camp. Something to think about (camp - not Residential Treatment Center (RTC)). But I think this will give me some real leverage when meeting with the SD, I hope; psychiatrist told me again difficult child is one of his tougest patients.

So - we're upping the Geodon to 80 mgs; and the Lamictal was upped last week to 200mg; we seem to have a lot of room still to work on the Geodon; it does work for difficult child and I know that eating with it is really important. From what I've read this seems to be one of the reasons that efficacy is low combined with too low of dosing.

Thanks for all the comments; it was all so helpful. It's helping me see past just stopping the aggression and major explosions. It's all simmering beneath the surface still; so in essence, he's been just maintaining for a long time and not really truly stable, perhaps.

 

[DammitJanet]

He is 12...so perhaps he could be engaged in starting therapy? There are some kids who seem to relate to an engine in there stomachs.

 

[Wonderful Family]

Looks like I never updated his age - he's 13 now and has been in therapy forever. I'll update the sig line.

One thing I wanted to add about difficult child; the "gift" that he gave to the psychiatrist was really saying what he felt straight out; mostly about beating other people up; how easy child forces him to go after him (not true) and how he has to make himself stop. This coupled with his irrational thinking and easy child's recent comments to me gave psychiatrist some real information for the first time in a while. psychiatrist treats easy child for his ADHD, so he knows him well and really understands how good easy child knows himself and will take what easy child is saying at face value. (easy child can tell me about the tingling feeling if he hasn't studied for a certain part of a test and how it goes away for what he does know.)

difficult child has no idea about the "engines"; we've tried this for a long time but he has no concept. I'm hoping the medication changes will help us get there. The only thing he can tell me is that he starts to sweat before he explodes and that he can't talk about the bad stuff-he doesn't know what it is. It seems like a big wall he has up inside. The only thing he's ever been able to articulate is what the stimulants physically do to him, and how he responded to different stimulants.

I worry so much about this kid because it seems like nothing really ever works that well for him; yet he does try hard in his own way, always has. It seems like he can never get past the really big stuff so that he can then work and do things like school or sports; things other kids get to enjoy.