Hi Concerned Mom,

Welcome to CABF, I'm glad you found us!

If bipolar disorder is suspected at all, it needs to be ruled out first as mania is very often misdiagnosed as ADHD and this can be a costly mistake.  Stimulants and antidepressants, can and more often than not, worsen the bipolar condition.  The result can be activation of mania, rage and aggression, even psychosis.  Your daughters reaction is very common and the very reason why bipolar needs to be ruled out first. 

Bipolar disorder is typcially treated with mood stabilizers and antipsychotics if needed.  First line mood stabilizers are Lamictal, Lithium, Depakote, Tegretol, or Trileptal.  Atypcial antipsychotic meds are Risperdal, Seroquel, Geodon, Zyprexa, Clozaril, Abilify, Invega, Saphris and Fanapt.  Antipsychotics are great at treating mania, rage and aggression, and any present psychotic symptoms.  Some kiddos require two mood stabilizers, even two antipsychotics on board to stabilize.  This link will take you to the current recommended expert treatment guidelines.  Many parents have found it helpful to print these and take them along when meeting with their doctor to use as a reference guide.  We have found it imperative to follow these guidelines.

All atypical antipsychotics have the weight gain potential.  Abilify, Invega, Saphris and Fanapt are supposed to be the most weight neutral. 

Suicidal thoughts are not a necessary symptom of bipolar.  Often depression manifests itself as irritability.  Take a look around our site, starting at the learning tab at the top of this page and then click on the getting started tab is a great place to start.  Take special note when you get to symptoms of mania and/or depression that she has had. 

Her sensory issues should also be evaluated - both by a doctor and at school.  You'll need to request an Occupational Therapy evaluation for the school to do this.

Here are some good articles to read about the difference between bipolar and ADHD - http://www.bpkids.org/learn/library/dsm-iv-mania-symptoms-in-a-prepubertal-and-early-adolescent-bipolar-disorder-phenotype and http://www.bpkids.org/learn/library/prepubertal-and-early-adolescent-bipolarity-differentiate-from-adhd.

This link will take you to a great article about pediatric bipolar disorder - http://www.bpkids.org/learn/library/about-pediatric-bipolar-disorder. And this link will take you to an article about how a bipolar diagnosis is made - http://www.bpkids.org/learn/library/how-is-a-bp-diagnosis-made.

Unfortunetly, there is a hugh shortage of child and adolescent psychiatrists, so finding one can sometimes be difficult.  I suggest starting a new post, and in the main heading put something like - Looking for pdoc in, followed with your city.  If you follow this link - http://www.bpkids.org/connect/find you can search by city and state for a wide variety of resources including physician's and therapist's. You can also search at the American Academy of Child and Adolescent Psychiatrist here - http://www.aacap.org/cs/root/child_and_adolescent_psychiatrist_finder/child_and_adolescent_psychiatrist_finder. This link will take you to a great article about questions to ask your doctor - http://www.bpkids.org/learn/library/the-doctors-visit-parent-checklist-of-questions.

One of the best things you can do is to chart and/or journal your daughter's moods and behaviors as this will become valuable information for the psychiatrist. Sample mood charts can be found here - http://www.bpkids.org/learn/library/mood-charts-list-of-several.

Finally, this link will take you to a great article called, Bipolar Disorder, Co-occuring Conditions, and the Need for Extreme Caution Before Initiating Drug Treatment. 

Hope this helps!  Know that you are not alone and that we are here for you!

--

Jackie aka mom2one
Forums moderator, FRT
Mom to Mr. 17 (dx'd at age 4), Bipolar, Psychotic Disorder, Anxiety Disorder, PDD, Cognitive Disorder
Meds: Seroquel 900 mg., Risperdal 4.5 mg., Fanapt 12 mg., Lamictal 600 mg., Lithium 1250 mg., DDAVP, and Synthroid .150 mcg
Fish Oil and Vitamin D
IEP, Therapeutic School
Married to my best friend and rock for 21 years!

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 My son was on risperdal when he was 4 years old.  First we put him on Strattera and then added the risperdal (small dose) for the aggression and tantrums.  He stayed pretty stable for 2 years when the doctor said his prolactin was elevated and we took him off.  AFter a few trials he has now been on Abilify 10 mg. for 3 years.  He does ok, not perfect.  But he never has the weight gain problem.  He is only 60 lbs and will be 12 in December.  He is very active on the go all the time.  I did hear that Abilify will not be as bad with the weight gain thing and it is an AP that is prescribed for children.

--

Mom,43, Anxiety, 50 mg. Zoloft,
DSS, 23, step-son, self medicates
DS, 13, ADHD, Daytrana Patch (only on school days)
DS, 11, Bipolar, ADHD, ODD, Anxiety: 10 mg. Abilify, 150 Wellbutrin
DS, 9, healthy
DD, 6, healthy
Married 7 years to DH, 46

Medicines tried: Intuniv (manic in 6 weeks), Zoloft (could of caused manic but unsure), Risperdal, increased prolactin -- Geodon, hyperfocused and obessessed all day -- Trileptal, 1 dose and was bouncing off the wall -- concerta, out of control in school -- Seroquel, anger, irritable, sucididal -- clonidine for sleep at times, tenex ?? -- Abilify now for 3 years and still wondering if he has akasthia or just hyper and can't sit still.

The problem is that they try various meds each affecting brain (and body) chemistry a little differently - almost shooting in the dark. Each child reacts differently. None of the meds tried in 13 years stabilized my older daughter (she is stable now) although some helped somewhat, while others made things worse. Abilify was horrible for her, but Seroquel was good combined with Lamictal, but it caused excessive drowsiness and weight gain. For the younger one, high dose Seroquel is what she got on after Risperdal caused too many side-effects and Zyprexa caused even worse ones. She didn't gain too much weight on Seroquel maybe because she was on Topamax, which helped ease migraines but cause cognitive side-effects. The migraines she'd been having though were worse than the cognitive side-effects. Seroquel helped diminish the hallucinations so that she could function, and it made her sleep at night.  Everything is weighed - good vs bad.

--"Naomi"
Older dd: teen-onset bipolar: Off meds and over withdrawal symptoms. After over 13 years - STABLE! Treated: Sleep, Candida, food sensitivities, nutritional needs, extra thyroid med.
Younger dd: Childhood-onset schizoaffective, with disabling migraines since infancy. Also off antipsychotic and meds for migraines. Stable - no hallucinations. Treated for multiple endocrine problems, food sensitivities, nutritional/mitochondrial needs, gut issues, SLEEP issues.