what does mania look like?

Discussion in 'General Parenting' started by agee, Nov 29, 2009.

  1. agee

    agee Guest

    Hey all -
    I've posted before about issues with-my son and school, but I have a different question tonight.
    I am beginning to suspect my 7 year old is bipolar. I will spare you all the long, long story of his various diagnosis and medications, but suffice it to say that RIGHT NOW he is diagnosis ADHD, although stimulants don't seem to help him after a month or so, and we've just started intuniv to see if that will work and I *think* I'm seeing mania.
    If he is bipolar he has mixed, rapid cycling episodes - today he seems somewhat different.
    He has been talking Nonstop since 1 pm (now 7) and almost seems as if he's vibrating. He is always highly impulsive but this seems amped up. He's also eating fast, running fast, talking fast, zoom zoom zoom! Normally he is very active, but this is maybe 4 times normal.
    I guess I'm looking for confirmation of my suspicions.
  2. smallworld

    smallworld Moderator

    I hope you will call the prescribing doctor and describe your son's reaction before giving him his next dose of Intuniv. Whatever is going on does not sound normal.

    Our psychiatrists have told us many times that a manic reaction to a medication is not in and of itself diagnostic of bipolar disorder. So even if this is mania, it will take more than this reaction to diagnose the disorder. For us, unfortunately, it has taken many years of clinical observation to get diagnoses for our kids. And in my son's case, the diagnosis is still not firm because he is a very complicated kid with numerous bad medication reactions.

    Hang in there.
  3. klmno

    klmno Active Member

    Hi! This link has a lot of useful info- scroll down and it might answer your question. While it's important to treat BiPolar (BP) as early as possible if diagnosis'd with it, keep in mind that BiPolar (BP) is one of the diagnosis's being thrown out a lot lately and just because you see some things that fit the criteria, doesn't necessarily mean this is the answer- especially when your child is only 7yo. neuropsychologist is great but can only do so much when a mood disorder is in question, in my humble opinion, but it can rule out other things and help with an IEP.

  4. klmno

    klmno Active Member

    SW was responding while I was typing- she actually is making the best point- don't assume anything as long as a current medication is in question- I made that mistake myself.
  5. smallworld

    smallworld Moderator

    I wanted to add that two kids in my BiPolar (BP) online support group who were taking regular Tenex had bad reactions when they were switched to Intuniv, which is essentially long-acting Tenex. So it may be that this medication may have needed more testing before it was released to the general public.
  6. agee

    agee Guest

    Sorry - didn't mean to imply that I think my son is bipolar because of his reaction to this medication - I am suspecting BiPolar (BP) because he fits most of the symptoms and because he's been diagnosis ADHD and ODD and the medications for those things do nothing for him.
    He does seem to be having a reaction to the intuniv, though - but I wanted to know if it sounds like what mania is, for those of you who are familiar with-mania.
    An aside - I am bummed about the reaction to Intuniv because it really sounded like it would help him. Stimulants have worked for a couple of weeks, then quit. SSRIs did nothing. Risperdal helps a little, but he is still moody and mean and foul most of the time. Intuniv sounded like it would really help his impulsivity...but maybe not.
    Aaaaagh! This is so frustrating!
  7. agee

    agee Guest

    What were their reactions?
    It's so new it's hard to find info.
    This is our 1st experience with-Tenex.
  8. smallworld

    smallworld Moderator

    One mom described her son's reaction as "agitated, angry and venomous, and those are the nicer things I can say." She also said he threw his violin bow across the room and screamed at his grandmother. The other mom said her son has been "agitated and very impulsive. It's driving me nuts!"

    Both boys did fine on regular Tenex, but were being switched to long-acting Intuniv so they didn't have to take several Tenex doses during the day.
  9. smallworld

    smallworld Moderator

    Agee, I went back and read you initial introduction to the board.

    What kind of doctor initially diagnosed your son with ADHD and ODD?
    Have you since had him evaluated by a neuropsychologist?
    Have you sought out either adoption or Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) specialists to evaluate him?
  10. klmno

    klmno Active Member

    Well, I describe it as acting completely out of character and irrational- whether the specific behavior at the times involves sexual interest, self-danger/harm, violence, no ability to sleep or whatever. (Dr. Jekyll and Mr. Hyde)

    I wonder though- and SW might be able to offer some insight on this- if he is truly BiPolar (BP), I would have thought the stims and/or SSRI's would have triggered mania- but you say you saw no effect at all after a couple of weeks of working. That doesn't sound typical for BiPolar (BP) to me, but I am far from an expert on this.
  11. mstang67chic

    mstang67chic Going Green

    I would talk to the psychiatrist before assuming anything. In my opinion it sounds like a reaction to the medication but I don't want to assume anything either. medications can set off all types of behaviors and that needs checked before anything.

    As for the mania... there are "official" descriptions and while those apply, it varies from person to person. Some people act like you describe your son acting, some stay up for days, some obsess on things....it varies. In my difficult child's case, he gets into cleaning mode. His room is constantly rearranged, my HOUSE gets rearranged, he cleans the house from top to bottom. Sounds nice right? Wrong. His version of cleaning is to pitch anything he deems unuseful. Things like mail, candle holders (they just SIT there), dirty towels (But Mom, it has DIRT on it), coffee mugs, etc. He will go through the cabinets and pull out things to decorate the house with. You can tell him over and over to leave things alone and he literally can't. Normally he has issues leaving things alone too but when he's manic, it's literally uncontrollable.
  12. smallworld

    smallworld Moderator

    It is very common for children with bipolar to experience a switch over to mania when they take SSRI antidepressants. Typically, this reaction occurs at the 3-week or 3-month mark and does not disappear once the SSRI is discontinued. But this manic reaction is not diagnostic in and of itself of bipolar disorder.

    Children with ADHD calm down and focus when they take stimulants. Children with bipolar may become hyper and revved up when they take stimulants. Again, this is not diagnostic of bipolar disorder.
  13. agee

    agee Guest

    You are so kind to have looked at my old posts.
    A child psychologist diagnosis'd him originally with ADHD and ODD - ADHD at age 4 and we then went to a child psychiatrist to manage medications. ODD has been implied all along. He sees a psychiatric nurse practitioner now, because we had trouble getting appts. with the first dr. - and I like the nurse better because he's less cautious about trying new medications.
    He is having a neuropsychologist evaluation. in January. I had wanted one earlier this year but we need to wait until the next deductible year. I took him this summer to a developmental child psychologist and I had hoped for a more thorough evaluation. but I got jack from them. All their report was was exactly what I had said - plus they thought I should take antidepressants because when they asked me how I was coping I cried a bit. ;)
    I haven't had an Fetal Alcohol Effects (FAE)/Fetal Alcohol Syndrome (FAS) specialist evaluate him although no one doubts that prenatal alcohol exposure is part of the issue. The thing is that is is of normal intelligence and has no facial features so as far as I've been able to discover it would be very hard to diagnosis. him with Fetal Alcohol Effects (FAE) or ARND, especially since we have no proof of it. So I'm not sure what good that would do, although I'm open to any suggestions or ideas or recommendations. We are switching health insurance to a HSA and we're going to blow out our deductible in the first 2 months - this is the year to get all the evaluations. that we can get done, done.
    Thanks so much,
  14. pepperidge

    pepperidge New Member


    I went back and read your first post. Just a quick note about our experience with our youngest who is Fetal Alcohol Effects (FAE). He has been extremely hard to medicate, to say the least. psychiatrists have told us that Fetal Alcohol Effects (FAE) can often make it much more difficult to medicate kids. Oppositional nasty, but also very sweet when things are going his way. Always in other kid's space, and very social at the same time. Not all autistic or on the spectrum.

    We started off on stimulants about 5 years ago since he had trouble focusing--they were a disaster, made him very anxious, tearful. Went through many other medications (probably about ten or fifteen), including two tries on Tenex, which built up over a course of a couple of weeks into very nasty violent aggressive behavior--so bad I sent my husband to a motel for the night after my son kicked in him the privates for the second or third time. You get the picture. Definitely a reaction to Tenex. I would really urge you to talk to your psychiatrist about the medication because I think it could definitely be responsible for the agitation and all that you are seeing.

    Prozac did not work at all for son--made him disinhibited.

    A psychiatrist finally prescribed low dose abilify which seeemed to help focus at school and make him less impulsive. Finally something that worked. But as he is going through adolesence now it seems to work less and we finally took him off. I was really reluctant to try other AP because he finds it extremely difficult to regulate eating.

    Mood stabilizers did not work. We have started him on Concerta, with some trepidation, given our experience of a couple of years ago. This time we don't see the same negative side effects. It has helped him at school though has not helped the nastiness at home.

    I don't at all think he is bipolar--he is just very inflexible, lives totally in the moment (can't plan ahead) and if something doesn't go the way he wants he reacts--nastily. I think it parts of the Fetal Alcohol Effects (FAE) thing which has definitely affected his executive functioning and his capacity for emotional regulation.

    I am still looking for a way to successfully parent him---it seems to be getting more and more difficult. I get so tired of my words always getting twisted, of fights over whether he has to brush his teeth before TV every night--if I forget to mention it, we have major anger, of just the constant arguing. Most things have gone into basket C, but I have not succeeded in making any progress negotiating on basket B. I sometimes feel like I am living with an abusive spouse, and believe me if it were my spouse, I would be out of here.
    It is just so hard to remain calm and detached all day long.

    I am not sure any of this will help you. We have been searching for a psychiatrist with a deep expertise in Fetal Alcohol Syndrome (FAS) but haven't found one. I think that some of what might be called bipolar type behavior is actually brain damage of some sort that isn't easily medicated. There isn't of course any way to test for Fetal Alcohol Syndrome (FAS)--when children are young, however, the facial features can be measured and a presumptive diagonsis made.

    Anyway, I would encourage you to ask your psychiatrist about a low dose trial (2.5 mg made a difference for us) of Abilify. It helped with focus and impulsivity both.

    Sorry if I have not been very encouraging. I think I echo what others are saying --be sure you are not trying to treat a side effect of a medication with another medication. I would d/c current medication before going to a different one so that you are sure what you are dealing with.

    Good luck.
    Last edited: Nov 29, 2009
  15. agee

    agee Guest

    Ok - here's his medications history:
    since age 4 he's been on every stimulant they make. Currently on Vyvanse. Helped at first - now, nothing. He always has to go to highest dose and with-in 3 months they quit working.
    He took Prozac for about 8 months. Now is on imipramine because of bedwetting. Prozac didn't seem to do anything. Imipramine definitely helps mood.
    Currently on Risperdal, 1.5 mg (.5 a.m. and 1.0 p.m.) Helps mood. Still foul most of the time but when we miss a dose or try to back down we see how bad it could be.
    Tried Strattera (again - we tried it when he was little and noticed nothing) and it lowered mood considerably at week 2 dose level.
    Currently trying intuniv. On 3rd day of week 2 dose. Last week seemed a little more calm (teacher reported at school - at home he quit making the weird little self-stimulating noises he always makes) but today it was like a switch went off and he got super speedy.
    I've read a lot about bipolar and although his reactions aren't typical, they also aren't off the charts. He's really young, you know?
    His dr. is not ruling out bipolar but he thinks he's too young for a decent diagnosis.
  16. agee

    agee Guest

    This is us, exactly. And I don't always remain calm and detached, although when I'm able to it really helps.
    I thank you for your input, although it's kind of depressing. I'll be calling the dr. tomorrow and we'll talk about Abilify. He's mentioned it before.
  17. klmno

    klmno Active Member

    by the way- has anyone mentioned the book The Explosive Child to help you deal with your child easier? If not, I highly recommend it.
  18. agee

    agee Guest

    I have it.
    I have all the books.
  19. smallworld

    smallworld Moderator

    Some people do better on Tricyclic antidepressants like Imipramine than SSRI antidepressants like Prozac. I myself am one of them, and I don't have bipolar disorder. I do great on both Nortriptyline and Amitriptyline (Tricyclics), but did horribly on Lexapro (SSRI) and Cymbalta (SNRI).
  20. Jeppy

    Jeppy New Member

    When my XH was manic he was unable to sleep for days at a time. I hope you and your son get a good night's rest tonight.