request opinions on medications

Discussion in 'General Parenting' started by klmno, Sep 11, 2008.

  1. klmno

    klmno Active Member

    I posted about this on Special Education to see how this might effect iep and now would like to get some opinions on whether or not you would do this.

    difficult child is on lithobid and this works as his first line mood stabilizer and takes care of mania and raging (at least we think it does to some degree). He's also on depakote er and that was added a year ago to take care of hypomanic sympotms, which were causing disruptions at school- such as excessive talking, inability to sit still, getting rowdy in the hall and at PE. He's also on risperdal PRN for when the lithobid isn't keeping up- primarily, late winter/early spring.

    psychiatrist says the lithobid is the only medication that is in therapuetic range for difficult child. But, difficult child apparently is super-sensitive to medications and reacts to very low dosages and medication changes. I believe the depakote is doing something for him- unless it's just coincidence that the continuous hypomanic symptoms became rare, but still existent, when depakote was added.

    The problem is that difficult child's grades dropped dramatically about the same time and difficult child started telling me and psychiatrist that he couldn't remeber things as well and couldn't digest what he was reading in textbooks, etc. We think it was the depakote and psychiatrist is willing to try lowering that dosage. I'm ok with trying that, too, since I know it isn't what is taking care of the dangerous and more erratic stuff. But, it would mean getting sd on board and in agreement so iep could cover any hypomanic activity during this trial process- if difficult child remained hypomanic, we'd have to decide what to do. Sheila, on the Special Education forum, said that it might mean removing difficult child from mainstream classes, at least temporarily. I would be ok with that if sd is, but I know sd doesn't want to put difficult child in Special Education class all day, even temporarily. But, I would love to see difficult child's grades go back up, especially as he prepares for high school.

    We tried switching out lithiuma and depakote for one mood stabilizer, but difficult child has strong reactions (bad ones) every time we tried to lower the lithium- I think he might need to be in psychiatric hospital if he ever needs to switch that one out.

    So, what would you do- try lowering the depakote or leave it where it is?

    We are supposed to have an iep meeting this month sometime and we have an appointment with psychiatrist next week, but I can postpone it if I'm satisfied that medications are appropriate as they are.
    Last edited: Sep 11, 2008
  2. Andy

    Andy Active Member

    If the depakote is causing mental blocks (forgetfulness, not understanding) than I would try to decrease it. We give our kids medications to help them control themselves and focus. If difficult child can not remember and knows it, it will cause more anxiety and frustration for him.

    If decreasing does clear the blocks then you will know that it was behind difficult child's complaints. Then if the other behaviors you don't want start to increase then you will know that it helped control those. That is when you will really need to make a decision - do you want difficult child to feel he can retain what he is learning or do you want the behavior better controlled? Or is there another option to address the behavior?

    The school may not want him back in a special class, but they have to do what is best for difficult child. I still think mainstream teachers should be expected to watch for signs of when they need to address difficult child's needs and not wait until he is full blown out of control. How hard is it to know that when difficult child starts talking out of term or appears restless or whatever the behavior is that you implement the IEP ASAP? They do not have to wait to see if this is normal kids stuff or will be a full blown episode. Treat is as a full blown episode starting. Is difficult child open to working this out? If a teacher tells him he needs to start the IEP process will he recognize it as the teacher helping him? If there is a teacher he does not like, he will not take it as well as if there is a teacher he does like.
    Last edited: Sep 11, 2008
  3. klmno

    klmno Active Member

    Thanks, Andy! You helped on the Special Education post, too. I'm already stressing over the second question you mentioned- I know there are other medications out there but difficult child has already tried a few (not as many as some people) and then, there is that issue that (if I understand correctly) a lot of mood stabilizers can cause cognitive dulling.

    I want him to really be able to retain it. The school just wants him to behave- and he's on probation and the courts want him to behave, although I think the judge would understand if she is informed of the details- she used to be a teacher so she sees the school's side but she also understands the importance of being able to learn.
  4. Andy

    Andy Active Member

    I am sorry, I meant that difficult child feel that he is not forgetting. If he feels he is retaining, then he will be. I think you are correct, the school wants a little zombie who will sit and behave. A true teacher would work with a difficult child to help that person learn. If difficult child didn't feel he was forgetting all the time, then he may feel better about learning. I know when I face certain things (like geometry because I can not remember the terminology) that I can't remember, I tend to not even try.

    There has to be a way to help difficult child's behaviors without turning him into a zombie. I also believed if the teachers were commited to helping and willing to recognize and work with warning signs, they would also be a big asset in helping difficult child learn to recognize the first signs in the hope that someday he can take more control?
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    My daughter took Depakote and had the same complaints. She was a teen and able to express herself well and basically said "I'm quitting this, because I can't think. It makes me stupid. I forget things. I can't do my work in school." And she quit. She also got the shakes and ovarian cysts from Depakote. Ovarian cysts are a risk for girls on Depakote. I would be looking at that, although Lithium can also cause cognitive dulling--I believe Depakote is worse. Both of my kids who were on medications are both no longer on them. My oldest is 24 and hates medications. My younger one doesn't need them, he was misdiagnosed. I'm glad--they caused so many side effects and problems, but some kids need them. STill, I think many psychiatrists overmedicate. JMO
  6. klmno

    klmno Active Member

    Yep- I think both things play into it- the better difficult child feels about himself and his capablities, the less anxious he is, the more motivated, etc. But, in fairness to the teachers, hypomaina in my son looks like a kid who has adhd and is not on medications- not the extreme cases, but it can drive a person up the wall. Now, if that were to last a long period of time, I would want a different solution. But, if it's temporary and intermittent, it might be worth it because he was on honor roll before depakote- now he struggles to pass. It's not all psychological.
  7. klmno

    klmno Active Member

    Thanks, MWM! Fortunately, psychiatrist seems to put a lot of weight on my input- although he will get stern if he is sure of something. Usually, we make a compromise- like "let's try this for a while" when that happens. Anyway, I am not fond of the approach where a medication has to be added to take care of a side effect so many times that a kid ends up on five different medications at one time, most of which are to counteract the effect of another one. Maybe sometimes that can't be avoided but I want to avoid it when possible. I didn't know depakote could cause shaking- difficult child would love it if his went away, however, I honestly can't remember if that only started after depakote was introduced.

    I was thinking- difficult child takes 250 mg of depakote er in am and 250 in pm. I'll talk to psychiatrist next week and see about taking off pm dosage for a while. Maybe the effect will just be making me crazy in the evenings and needing to do homework at school so he isn't trying to "settle down" to do it after the first dose wears off. Then maybe, he might do better understanding homework this way- if I can get him to sit down long enough. LOL!
  8. smallworld

    smallworld Moderator

    My son had a similar experience with cognitive dulling, but his psychiatrist blamed it on his large dose (800 mg) of Seroquel. Paradoxically, as we lowered the Seroquel to 400 mg, J's cognitive dulling worsened. We then realized it was the Zonegran that was causing the dulling. So . . . we increased Seroquel back up to 600 mg and then decreased Zonegran from 400 mg to 300 mg. His cognitive symptoms improved.

    Recently, in anticipation of the start of a new school, J's psychiatrist increased Seroquel back up to 800 mg. J is the best he's been in months. He's actually been doing his homework!

    This is all my long way of saying I think you should try lowering the Depakote. Maybe an AP could be used if hypomania occurs.
  9. klmno

    klmno Active Member

    Thanks, SW! I'm thinking we aren't at the best and final mix of medications yet. It's just that we found something that keeps difficult child relatively stable most of the time and we had to let that last for a while without taking even the slightest risk- legal issues, you know.

    psychiatrist wasn't fond of seroquel for difficult child- I don't know exactly why but he did say that given difficult child's high sensitivity to medications, he thought it would be risky to put him through the process of getting him to a good therapuetic dose. He said difficult child could end up feeling knocked out for a week, for one thing and school has been an important factor- because of sd and the gal was involved at that point. Also, psychiatrist said he preferred risperdal for difficult child and I read that rispersdol is good for raging. Anyway, I am open- especially if it means less medications in the mix. I guess difficult child's mix isn't all that many, but lithobid only coming in 300 mg pills means that difficult child takes 6 pills a day- on a good day.

    The other "option" I threw out to psychiatrist- what if, as difficult child is growing very fast and weighs more, instead of raising the depakote dosage as would normally be expected, we keep it where it is and let the growth/weight start outweighing the dosage, if that makes any sense. He said he'd leave this one up to me as a trial because it's the lithobid taking care of the major stuff.
    Last edited: Sep 11, 2008
  10. smallworld

    smallworld Moderator

    According to our psychiatrist and neuro, Seroquel is a "softer" AP than Risperdal, particularly when it comes to side effects. It's especially good for anxiety and depression, but also helps with mania and general mood stabilization. It does cause sedation, but paradoxically, sedation lessens as the dose increases. If you are concerned about sedation and school, you could introduce it over a school vacation.
  11. klmno

    klmno Active Member

    If he was on seroquel, let's say to take the place of depakote, could we still use another AP, such as risperdal, as PRN for late winter/early spring "episodes"? I mainly ask that because as bad as I hate to say it, difficult child cannot afford another "risk" of untamed mania. If I have to give him something to make him sleep for 12 hours to get him past it, I will, until we have a better solution. I'm aware that seroquel is a mood stabilizer and not so sedating at higher doses, but if difficult child hit mania anyway and he was on seroquel, what could you use to purposely get him sedated?
  12. smallworld

    smallworld Moderator

    Seroquel is an atypical antipsychotic, not a mood stabilizer. For PRN, some use additional Seroquel or another AP like Risperdal. I don't think that's a problem.
  13. crazymama30

    crazymama30 Active Member

    I would try lowering the depakote, and maybe go to an AP like smallmom said. My son does not take ap's, but husband does. He tried Geodon, which was great but he developed a side effect. That was a big time bummer, because it worked so well. Now he is on Abilify, which is almost as good. It was hard to get through the first 2 weeks, as husband I believe had Akanisethia (feeling like your driven to do things, if I have my terms right) but that did wear off and now he can sleep and function almost normally. husband is very sensitive to medications too, he is on 5mgs of Abilify. His biochemistry is super weird.

    It would be hard to be in school and have that cognitive dulling effect. But I would be leary about changing medications too. Will the school be understanding during this time period? I would not want to see him get in more trouble. That would be awful too.
  14. crazymama30

    crazymama30 Active Member

    I also forgot, in adults many times Atypical antipsychotics are used as mood stablizers, and if I remember right Seroquel was one approved for that. Many are used for it anyways.
  15. klmno

    klmno Active Member

    If I want to lower the depakote, I will keep appointment with psychiatrist next week and have prescription changed but will not implement that change until IEP meeting. At least, that is my thought on it right now. It will pull more weight with sd if psychiatrist has "ordered" a change, but I would be too scared in thuis situation to lower it without having IEP with a plan for effects in place.

    Yes- correct- I worded it like it was a first line mood stabilizer, but you and SW are correct- it is an AP that can be used as or with a mood stabilizer.