9 year old ??? Bipolar NOS
Ok I posted a little while ago but now I am more torn than ever. Have 9 year old girl with extreme tantrums since young age... everyone said she'll out grow it, I always knew something was off... Anyway she can be 100% normal and keeps it together at school, and with other people but when she gets home to her comfort zone she can blow. It is like walking on egg shells. It worsened over the summer with her being emotionally exhausted and she got a bit depressed... Husband finally agreed this it not normal.
Saw a counsellor then a psychiatrist and she started her on Abilify 2mg. We had a different child for 4 weeks then by 6 weeks were back to the old ways, upped the dose got aggressive, and tons of anxiety. dropped it back to 2mg and added tofranil 25mg at bedtime for the anxiety 4 weeks ago
So it seemed to help the anxiety- great but I am not convinced the abilify didn't cause the anxiety in the first place?
This past week she is, very irritable, miserable, edgy, hates every one, more aggressive physically( Normally unmedicated she is just verbally aggressive, door slamming...) Now she is wild, you can see it in her eyes. Afterwards she sobs, remorseful... I can't parent her as she thinks we are all mean, rude and horrible (? Paranoia). Overall she is either great or awful.
At first I thought she was severe mood disorder or TDD, not bipolar. But now I am wondering. She says when she blows it's like being hit with a cannon. Also wondering as since we added the tricyclic(Tofranil) she seems worse, are these increased outbursts like mania? Caused by the use of an antidepressant with a bipolar kid? If she is Bipolar could she keep it together at school? Or is it just going to escalate? She has no ADD signs, really mostly irritability and tantrums. We have no family history of mental illness although there is alcoholism in our families which I read can be a red flag.
I am an RN and have read and researched a ton but am so confused. Starting to think we should get her off both the abilify and tofranil as they are not obviously working and get her on a mood stabilizer, which from what I read is first choice for bipolar treatment? Then the question is which one- she is petrified of needles so that puts lithium out I think?
Any advise would be appreciated, thanks
Welcome to TBMF. The medication part of treating BP can be so confusing. Everyone reacts differently to different meds, but there are Expert Treatment Guidelines available. The general principal is to use MS's ( mood stablizers)as first line meds. However, it is extremely common for pdocs to initially prescribe an atypical AP of some sort. It used to be Risperdal that was used all the time, now it's Abilify. Anti-depressants (AD's) can cause incr. cycling, agitation, or mania in people with BP, especially if they are not adequately stabilized on MS's. This doesn't always happen, but it is definitely a risk. If you are seeing worsening of sx after a few weeks on Tofranil I would be suspicious of that.
Abilify works like magic for some, but it can definitely cause anxiety in others. Also, there is an ideal dose of any psych med for each individual. For your dd, 2mg may be the ideal dose of Abilify. More is not always better!
Has your dd had a thorough neuro-psych evaluation? This is so important when getting our children dx'd, and it's also helpful down the road as sx change. It is also essential to rule out organic illness such as thyroid problems, seizures, etc. You may also want to get her allergy tested, and make sure she is sleeping well, as these can also contribute to psych. sx in children.
Alcoholism in the family tree is definitely a red flag for mental illness. Many people with alcoholism have underlying psychiatric disorders, and in years past these often went unidentified and untreated.
I hope this will help you with your immediate concerns. If you haven't done so already, I encourage you to go to the "Learn" tab at the top of the page and click on "Getting Started". This is an introductory article with lots of info and links about all issues of childhood BP.
Best of luck, and let us know how things are going.
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Brenda,51, TBMF Parent to Parent Volunteer
Mom to A, 17, BP, Tourette's, OCD, ADHD: Eskalith CR, Lamictal, Cytomel, Allegra
E, 15 1/2, BP,AS: Seroquel, Eskalith CR, inositol, Buspar
B, 14 & H, 11
Married 18 years to DH, 50
FROM TBMF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.
Thanks Brenda the info you provide is very helpful. I hope things go ok today with the psychiatrist. see the ped on 26th to do baseline workup...
Michelle