Well, I Think We're Going To Play With Some Drugs

[Janna]

so if you guys could keep fingers crossed for me, I'd really appreciate it.

Dylan! The Lithium is definately staying. He's still good at 900 mg., right around .90.

We have been weighing the good vs. the bad on the Abilify. I am very uncomfortable continuing on with this medicine, for the weight gain problem alone. Dylan is huge, and no matter how much we try to cut back, and how much he HAS cut back, he is not losing one ounce. In all honesty, his things just keep getting tighter and tighter, and bigger and bigger. Think Michelin Man. Pillsbury Dough Boy? He's huge. His double chin is growing to a triple. We (psychiatrist and I) are both pretty sure it's the Abilify moreso than the Lithium. The Lithium cannot go.

So, we're thinking about removing Abilify and adding Concerta :nonono: Yes, I'm a lunatic :rofl:

I am still tossing this around in my mind until our next psychiatrist appointment, which is a week from tomorrow.

I know what stims can do to BiPolar (BP)'ers, we've trialed them all. Although, alone. Yep, I'm a teeny worried. But, his ADHD, the ADD part, is bad. I wonder now, a couple of years later, more stable, having been so calm so long, if this could work.

I think I would like to try. The nice part - if the stimulant doesn't work, we can do a switcheroo right back to the Abilify.

But I think I'd like to try this.

Lord, help me LOL!

Thoughts? Suggestions? Eek.

Forgot to add, the reason I don't want to ADD the Concerta, is because I don't want him on too many medications. I know, maybe selfish on my behalf, but would rather try it this way, unless there's a really good reason not to?

 

[tiredmommy]

Janna,
I've got to admire your bravado, lol! Good luck, body parts are crossed here.

 

[BusynMember]

Janna, it was the Lithium that sent Lucas from 100 lbs. to 150 and he gained every month until we cut it out. You may want to try Topomax with it, but Lithium is a weight gainer. Our psychiatrist once showed me a chart of the five biggest weight gaining medications. If I recall, it was the first atypical antipsycotic that came out (I forget it's name--not used much anymore), Risperdal, Zyprexa, Depakote and Lithium. A friend of mine takes Lithium and she's enourmous. Lucas is still a big boy. He hasn't lost the weight. He's only gained about five pounds since stopping Lithium three years ago, he's grown about six inches, and he's STILL overweight. The poor kid used to have trouble walking. That was one big reason I wanted another opinion. I didn't feel he had bipolar but may not have been as proactive if he hadn't blown up so big!

 

[Janna]

He really can't stand the weight, MWM. It's not just me, it's him. He's so self concious. It's really hurting him.

If it turns out to be the Lithium, I dunno what we'll do. We may just have to tolerate it, but he is really, really huge. And the thing is, he doesn't really eat alot.

I remember when he was on the Risperdal he was obese. And within 3 weeks of disc. it, he was all the way back down again. It was like a miracle.

I just can't have him this heavy. Even the psychiatrist, checking his cholesterol and stuff, puts diagnosis - obesity on his script. I hate that. He's only 10 :frown:

 

[Wiped Out]

Keeping fingers crossed that a new combination will be helpful.

 

[needabreak]

have my fingers crossed every thing works out.its a shame we got to play guessing games with our childrens medication.there like little gunie pigs and there nothing we can do but to keep trying till we find something that works.

 

[smallworld]

FWIW, my son is on a stimulant (Focalin XR) with a mood stabilizer (Lamictal -- we'll be weaning off Depakote soon), and he's doing fine. But he did fine with stimulants for several years before Zoloft sent him into mania. We use a low dose and watch his moods like a hawk. So far, so good.

This is just my thought, and obviously you should run it by the psychiatrist, but I'm wondering whether you should just trial regular Ritalin before going to Concerta, which is simply long-acting Ritalin. The reason I'm suggesting this is because Ritalin lasts 4 hours and Concerta lasts 10 to 12. If you have a problem with Concerta, it's going to take a whole lot longer to leave Dylan's system. Once you know he does OK with Ritalin, you can easily switch over to Concerta.

One reason not to deep-six the Abilify before starting a stimulant is if you think Abilify is helping with anxiety. Stimulants are notorious for exacerbating anxiety. And stimulants often help with appetite suppression. My son frequently doesn't eat very much at lunchtime (not a problem because he's overweight, too).

Another thought: Are you sure his inattentive ADD symptoms are not caused by cognitive dulling from Lithium? Lithium, like the mood stabilizers Topamax and Neurontin, are known for cognitive dulling side effects. I'm not sure what is done to ameliorate this side effect, but I think it's something to consider.

 

[jannie]

Hi Janna-
I understand the weight issue. difficult child is up to 80 pounds and he is only 7 years old. :nonono: He is tall, but still it is way too much !! It is so hard to control the eating.

I think it is worth a try. Are you planning on trialing the stimulant while still on the abilify or are you planning on cutting back the abilify first? Stimulants don't seem to be an option for us because difficult child is prone to tics...

Fingers crossed it all goes well

 

[Janna]

I'm not sure Smallworld. I don't know what cognitive dulling looks like.

I see Dylan's inattentiveness here at home. He starts something, 15 minutes later, he's bored, moving on to the next thing. The teacher at school reports he has a really hard time focusing, staying on task, and he needs redirected alot.

He did have that sleeping issue, I'm sure you remember. I guess maybe it was anxiety, but it kinda nodded off with the Abilify. There have been a few nights I've forgotten to give it to him, and he still goes to sleep okay, but not so many nights in a row. Just a night here and there.

I don't know if Dylan's ever really had an anxiety problem, or if he's just unsure of himself. The teacher reports, in school, academic wise, Dylan seems to have an esteem problem. He doesn't think he can really do the work himself without help. Although, over time, it is getting better (and he's bringing homework home, too, now, and he's doing alot more grade appropriate work, and getting tons of high fives and good jobs for that, and it's helping with the esteem).

The Ritalin is a good idea though. Thanks for reminding me of that. I wrote that down. I did mention the Focalin to the psychiatrist before. I don't recall why we didn't discuss it in detail, but he didn't want to. Maybe I'll have to bring that up again (like all psychiatrists, I'm sure he has his favorites, is probably all it is).

I'd prefer this just be easy. Guess it's not happening that way. I was just hoping (wishful thinking) now that Dylan is doing so great, and he's really seemed to pick up on so many positive things, and he's rolling along with everything like he is so fantastically, this might work.

My biggest concern right now is the weight. It's horrible :frown:

J

 

[totoro]

Good luck Janna-

I thought Abilify was one of the AP's that was supposed to cause less weight gain??? My difficult child is already so self concious of her tummy... it must be so hard

As if these poor kids aren't suffering enough... yeah do you want to hear voices and bark at the moon or gain a 100 pounds??? Who wants to make that decision???
And what sucks is that the kids self image can be damaged so easy.

I am wishing you a smooth transition in the days ahead...

 

[amy4129]

Janna-
even though ken's weight has been stable he is "fluffier" on abilify. But i can't argue with the help it has been. everything crossed!
Amy

 

[BusynMember]

Janna, Lucas still says "I'm fat." He is self-conscious. At least he isn't gaining any more weight. When he was on Lithium, he gained EVERY MONTH. Maybe it was because of the combo with the Seroquel, but he was huge. I was terrified. The kid had open heart surgery as an infant. His cardiologist didn't seemed worried, but I sure was. I still wish he'd shed some weight, but he's no longer an active kid. He's still in the 150's and about five feet tall so he's still overweight. Imagine what it was like when he was shorter. It's a real dilemma when a medication works so well in one way, then causes this weight gain...big hugs. I don't know what to tell you, but Topomax is known to stem weight gain with Lithium/Depakote/whatever. Lucas couldn't take it, but maybe Dylan can.

 

[pepperidge]

Janna,

Here's my experience for what is worth. my youngest is on Abilfy. It led to some weight gain but not huge at all. My oldest is on Risperdal. That would have led to weight gain, had he not been on a stimulant.

My youngest the one on Abilify tried all the stims, but all made him very whiny. We just trialed Focalin (while he was on the Abilfy) but that led to more aggression I think and more obsessiveness so we have decided to d/c the Focalin.

My oldest started out on Adderall, and did well on it, except for the rebound was pretty bad. Now that we have added Lamictal and everything else, it continues to do wonders for him.

By the way, Topamax has had no effect on either boy's appetite, so I am really wondering why we didn't see that side effect, when we saw everything else.

Good luck--at least with the stims, you know what you get pretty quickly, though I have to say this last go around, we started low and it was not clear what effect the Focalin was having. (better than a bad effect!)

 

[DammitJanet]

You really may want to ask about trying topamax with the lithium simply for the weight loss side effect if the ritalin doesnt work.

 

[crazymama30]

Good luck. I do not know much about these medications, but I am sending good vibes your way.

 

[dreamer]

my oldest did not do too bad on plain standard Ritalin...BUT she took that as her very first medication and the only medication for a few years, and she took the lowest possible dose and she only took it 7 am and 11 am....and she did not get it on weekends or school holidays.
My son never trialed Ritalin, they used concerta and adderall on him, he was on lowest possible dose of those and had horrendous headaches (and increased seizures we realized once they identified the seizures) and he could not eat AT ALL, NOTHING..until his 7 am dose wore off at approx 11 pm. (but poor kid had to get up for school at 5 am, and would be SO hungry at 11 PM he would sob his lil head off) Before we knew he had seizures, I kept begging the docs to try ordinary Ritalin, thinking we would have more control that way. BUT they would not go for it.

 

[Janna]

We tried Topomax before. Maybe in 2002/2003. I have everything in my other computer. I know he trialed it alone, and it didn't last long, but I cannot remember why we d/c'ed it.

I dunno, isn't that Dopamax?

Another thing, that cognitive dulling, is that why his speech is so slurred so often? Heck, people cannot even understand him sometimes. And he constantly has a puddle of spit in his mouth, why is that? I don't need another medication to make him like that.

And you know, his expressive whatever that is, when he tells stories - again, nobody understands him. His thoughts are scattered all over the place. He'll try to tell you about a boy and what he did in school today, he'll start out by saying "Joe picked up the chair and went to throw it" - and then, right in the middle of that, switch to tell you about how he met Joe 2 years ago, then go back to finishing his story. He's all over, and nobody understands him.

I love how calm and better behaved he is (although I'd like to hope the better behavior is because of so much of our hard work, and not solely because of medication), he has a much better handle on his emotions, but over time (I know, it's only been a year), I'm not liking alot of things about the medications. Take the good with the bad, yes, but I don't want my son zombified either.

And no, I don't want to add the stimulant to the Abilify. I would d/c the Abilify and add the stimulant. I don't want him on too many medications. He's already taking 2 in the AM (Lithium/Synthroid) and 3 at night (Lithium/Abilify).

Thanks for all your thoughts and suggestions. I appreciate them.

Janna

 

[kris]

let's face it....managing medications is more fine art than science. there is never an easy decision when it comes to this stuff.

since the lithium seems to have been dylan's magic bullet, i'd be very hesitant to d/c that one too. if it were my child & i really wanted to d/c something it would be the abilify.

if he's going to react to the stimulant i would think it will happen quickly....and hopefully not destabilize him too badly. on the other hand, i've seen reports here that kids, once stabilized on a mood stabilizer or two, are able to handle the stims.

hopefully this won't be too nerve wracking for either one of you & you will get the results you are hoping for.

kris

 

[FlowerGarden]

Lithium is making my difficult child eat like crazy. Unfortunately, it hasn't been helping him either. Every time we increase it, he seems to get worse instead of better.

The psychiatrist that he saw, about 5 years ago, had given him some type of antacid to take half an hour before meals to stop overeating urges with the medication he was on then. I can't remember the medication that he was taking but I remember the antacid was Pepcid. I just don't remember the strength of the Pepcid. It did seem to help.

I was reading an article on dieting tricks in a magazine while waiting for an appointment the other day. It suggested putting a fiber mix in a drink and drinking that a half hour before eating. They said it makes you feel fuller so you eat less. Have no clue if it works.

 

[DammitJanet]

Some folks call Topamax Dopamax but I dont think anyone would accuse me of being stupid! I do have a small amount of word retrieval problems but it isnt that bad. I can work around it.