Prescription Roulette
Greetings! I am new to the forum (and posting overall), so please bear with me!
I've been working to get my son Daniel, 6, the correct diagnosis and help. At this point, he is being treated for BP, ADHD, ODD and SPD. Currently he is taking Depoken (5ml 2x daily), Abilify (5ml 2x daily), Prozac (10ml) and Strattera (40mg 2x daily).
The challenges he faces is spontaneous physical acts on others (headbutting, pinching, squeezing, hitting or kicking). He is currently 6 1/2 years old, but academically, he is 6-12 months delayed. He's been seen by every "...ologist" and specialist around. In fact, we went to our local university to see the "leading" Child Development team and their response was, his problems are all related to his below-average IQ.
At this point, I feel we've reached a stand still with the neurologist. He admits that we need to find something to help D with focusing in school (resulting with improved academics) and stopping the impulsive behaviors. However, the doctor keeps trying to put him on amphetamine meds (focalin, metadate, vyvanse and most recently Dexodrine). Every time we try one of these, D responds negatively. We recently tried Dexodrine and he was awake for almost 48 hours (only had 5 hours of sleep) along with a drastically heightened OCD tendencies.
I see there are so many Rx available and combinations and just don't know what to subject him to next. I am looking for suggestions or guidance based on your experiences!
Thank you all for your help!
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Mom to Daniel, 6,
Dx Pediatric BP, ADHD, SPD, ODD, IED (IDK GMAB)
Meds:
Depokene 10ml, Abilify 10ml, Strattera 40mg, Fluoxetine 10 ml
Hi,
Welcome to CABF, I'm so glad your found us!
Bipolar disorder is normally treated with two classifications of medications - first line mood stabilizers and antipsychotics. First line mood stabilizers are - Lithium, Lamictal, Depakote, Tegretol, and Trileptal. Atypical antipsychotics are Ripserdal, Serqouel, Zyprexa, Geodon, Abilify, Clozaril, Invega, Saphris, and Fanapt.
Your son's reaction to stimulants is very common when you are dealing with bipolar. 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. Often mania is misdiagnosed as ADHD and this can be a costly mistake. Expert pdocs will tell you that you need to first stabilize the mood and then you see what is left over to treat.
Strattera, an ADHD med, that is a non-stimulant has also caused activation with a lot of kiddos. You'll want to make sure it's helping and not worsening symptoms for your son.
Here is a link to the current expert treatment guidelines for bipolar management. Many parents have found it helpful to take these along when they meet with their doctor to use as a reference guide. We have found it imperative to follow these guidelines.
Depakote (Depokene) is dosed according to symptom relief within blood therapeutic levels. The therapeutic range for Depakote is 80-125. Kiddos who rapid cycle tend to do better on the higher end of the scale. I always recommend to parents that they ask their doctor what the actual number is and to keep track of it. Don't just settle for an "it's fine, or looks good" response from your doctor. Depending upon what your son's level is this may or may not be the right mood stabilizer for him.
The only way to tell what is working and what isn't is to chart your son's moods and behaviors. Sample mood charts can be found here. These charts can be a very valuable tool for your doctor.
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. These two articles talk about the difference between ADHD and bipolar disorder - 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. Finally here is this article - Bipolar Disorder, Co-occurning Conditions, and the for Extreme Caution Before Initiating Drug Treatment.
Who has been treating him - a neurologist? It would be best if your ds was evaluated by a child and adolescent psychiatrist - one who is highly educated and successfully treats bipolar disorder. 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. Another great place for finding resources that you may be in need of is to post on our message boards.
It also sounds like your ds would benefit from having a Neuropsycholigical Evaluation done by a qualified Neuropsychlogist. A Neuropsychologist and Nerurologist are two different doctors. Having a complete evaluation done will help pin point exactly what is going on with your ds.
Is your son receiving services at school and does he have either a 504 plan or IEP?
Know that you are not alone and that we are here for you!
Hugs,
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!
If CABF has helped you, please consider a donation! https://www.bpkids.org/donate?campaign=forums2010
My main recommendation is that you find a well-respected child psychiatrist who is experienced with treating childhood bipolar disorder. My apology if you have already tried this.
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Tim