How did this happen?
I apologize in advance if this a bit lengthy. My dd is now 17 1/2. This is a child who NEVER had any issues whatsoever in school or at a home. She was a role model student, socialized easily and any teacher she's ever had including her teachers now would be shocked with her probable diagnosis. Her first year of high school was challenging but she excelled as she usually does having three honors classes and being on the swim team. She did not like swim and had a hard time fitting in with no friends on the team and her first real experience with cliques. She finished then year and did not continue swim the next year. 10 th grade she began complaining her friends were boring and I think she began to feel the pressures of not being in the "popular" group or having boys socialize in her group. She and another friend decided they were interested in a small private religious school where the director preaches they don't have cliques everyone is including etc. I never bought into it but my daughter did. Her best friend left and went to this other school. We caved in and let her go for 11 th grade. Her illusion that she would just transition right it and become instant friends with everyone did not live up to her expectations. These kids mostly had been together since elementary school and it was hard to merge in. Her best friend had an easier time and proceeded to dump my daughter as a friend. My daughter had never even had a fight with a friend let alone be dropped as a friend. This sent her into a Major Depression as she had no real support system at the school on top of the tremendous pressure of 11th grade. AP classes, SAT etc. I caved in and agreed to start her on an SSRI. As a former pharmaceutical rep I know more than I'd like to about drugs and feel many do more harm than good. That being said we had to get her out of the depression and she was started on a low dose of Lexapro. She seemed to do ok and then would have an episode of depression again. The highly regarded psychiatrist atinstructions tuition always had a reason why the depression came back. We increased dose slightly and I noticed what I learned was possible hypo manic behavior. Probably more like hyper but still not typical. My belief was it was Ssri induced hypomania. Psychiatrist said it was normal teen behavior. Fast forward almost a yr later and with new doc who says my dd has atypical BP. I am not in denial but could explain all of her behaviors good and bad as typical teenage behavior. What's not typical is crashing into a deep depression almost monthly. Also thought she had PMDD but now have had two rounds of no PMS and crash after period. Currently on 50mg. Zoloft, 100 Lamictal which was supposed to be the answer and with finals next week caved into starting her on Lithium of 300mg last night. I am sickened by this cocktail of meds yet nothing seems to be helping. Sorry for the rambling and typos from iPad typing. Could this have all been induced by theSSRI or is she inded BP? Any thoughts ? Thank you!
You ask how did this happen. Like you, when my kids first got depression I analyzed their lives and recent events and what led to the depression... The HUGE point I was missing is that we can ALWAYS come up with some THING, some EVENT to blame this on when the simple fact is it is medical/biological. When it is a cold we say, oh it was because I went outside when my hair was wet, or I was stressed or I used be be stressed and then I had a chance to relax, or it was because xyz... We can ALWAYS find something in our life to blame it on, when the fact is we simply got a virus our immune system was having a hard time battling. And Depression? it is only a symptom... it can be a symptom of over 100 different things. But I analyzed to come up with some THING emotional, life-event stuff to blame that symptom on.
And then... just as in your story, SSRIs came into the picture and the depression "progressed" to bipolar disorder, and in one child that then "progressed" to schizoaffective disorder (a schizophrenia on top of the bipolar).
How did it all happen? My older daughter, like yours was doing incredibly well in high school. She had an active life, was happy, socially well-adjusted.
Oh well. What happened? Really? Well, firstly, it was just illness same as any other. For the older daughter, she needed higher thyroid levels. Why? What the doctor says is there are so many reasons that thyroid hormones are not being converted or utilized as they should. There are even different ways to have low levels. And, she needed to be off gluten... actually all grains. Dairy was making her crazy, but that may have partly been worsened by the intestinal issues we didn't even know she had from the gluten.
And my younger daughter???? Why? I have been around and around that question myself. What came first? In any case, I see everything revolving around inflammatory responses. Even the stress which exacerbates ANY illness... exacerbates inflammatory response.
--Jeanie aka "Naomi"
It's Not Mental
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added a little EMpowerPlus back on as a multivitamin simply because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.
Jillh,
In answer to your question, yes this could all have been precipitated by the SSRI, but ask yourself, why was she put on the SSRI in the first place? Clearly something was already going on at that time. For many folks with BP depression is the initial mood swing they experience. So it could be that your dd was entering into BP with depression, and the SSRI just accelerated the swing into instability. It's really hard to know at this point. We had that experience with both our boys and with myself. I would personally be hesitant to continue giving her an SSRI at this point, but at least you know to monitor her closely. It could be that you could slowly wean her off it now that she is on the Lamictal and Lithium. This is something you might want to discuss with your pdoc.
Also, it seems that her behavior started changing at the beginning of high school. For someone who has been so successful, it seems like she should have been able to make new friends, especially with a sport that offered a built in peer group. I am guessing that she was already struggling with life at that point, or perhaps earlier, even though she didn't share her internal struggles with you. Teens are very good at hiding their inner lives from their parents.
I would also be suspicious of something hormonal going on. The cyclic nature of her depressions does sound like PMDD. One of the treatments for that is an SSRI given every month before the period. The fact that she is doing well on Zoloft + a MS sounds like she could very well have a predisposition to BP. Low dose lithium is probably the safest drug she is on--it is so helpful for atypical depression and BP of all types. Her thyroid should definitely be evaluated, since high or low thyroid causes sx that look exactly like "Mental" illness.
Medications are only part of the answer to stabilizing moods however. She will also need to address her diet, activity level, sleep and stress management. For now, the meds are bringing her relief, but she will need to make lifestyle adjustments in order to feel truly well. And if she is stabilizing, this would be a good time to find a tdoc for her. Therapy really only works once there is some stability, but it can be good for helping the person learn how to manage their illness.
--
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.
Hi Brenda ,
I agree she was put on an antidepressant for a reason and something was probably going on that we didn't know. I urged her to do swim exactly for that reason...a built in peer group. It backfired...swim is an individual sport not a team sport and the coach did nothing to encourage any team like atmosphere. He didn't coach or encourage and she was just an ok swimmer. To make it worse wter polo recruited a bunch of girls so they left together and then came back together in spring to swim. They had bonded as a group which made it harder to fit in or at leas harder for my dd. Just bad luck i guess. The difference is she handled it and managed quite well.Something she can no longer do.
I agree and so does the pdoc she needs to be weaned off the SSRI however right now she is highly depressed and I want to wait until she comes out of the depression. I have been suspicion about hormonal swings and we have considered putting her on the pill continuously so she doesn't get her period at all. Problem is a soon as we tracked the depression to premenstrual she had two months after with no PMS symptoms and depression following her period. Unfortunately stump the doctor is never the position you want to be in. Nothing about her symptoms are presenting as typical. She is in therapy and the therapist also agrees she is presenting very atypically. Not a cut and dry diagnosis.
Just got her thyroid tests back and all is normal. I do think stress is a contributing factor and she needs to exercise. She is also on Deplin and omega 3s.The problem is the meds aren't really bringing relief. I was so confident that Lamictal would be our answer but don't think we gave it a good enough shot and she still has room to go up in dosing. I agreed to start the lithium as well in a panic because she has finabecoming up. Not to sure if it was the best decision. I guess now it's just wait and see. Much of what I've read is contradictory about lithium. Depression is her real symptom and I've read lithium will help and also it won't. The hypo mania which is more just like elevated mood is not a problem per se. It's the crash into a debilitating depression that is a huge problem. It appears some here are doing the no wheat / dairy and supplement route and I respect that may help with some. Tried with my younger daughter when we thought we were dealing with an issue that she plain old grew out of . The diet change supplements were difficult expensive and just didn't work for her. My father was a health nut scientist who also believed in many of those theories. He had all mercury removed , detoxed from candida for years , no wheatn no dairy. More vitamins supplements than you can imagine. He recently dropped dead of a heart attack just after his 70th bday. I think this is an organic brain thing and need to focus on that and finding the least amount of the right med. Thank you for responding.
Just a heads-up.... we were told the same thing. Repeatedly. Even though both kids had symptoms of hypothyroid. They needed their T3 & T4 in the UPPER range, and for a while, the older daughter needed it right on the cusp of hypERthyroid (according to lab ranges which don't reflect what is actually going on with the utilization). So many factors go into the body's ability to utilize the actual hormones -- even nutrients like Omega-3s and other hormones!I am not saying at all that is the case with your daughter. In fact, my younger daughter needed progesterone as much as she did the thyroid, but the older daughter did not, so of course, every case is different.And for my older daughter, the raising of the thyroid, was only a small piece.
But here is an article on CABF about thyroid hormone: Hypothyroidism: Is It Contributing to Your Child's Symptoms?
and here is more: Brain Health: Thyroid Hormones
What I have learned is it wasn't anyone's fault nor was it any event. It was just illness.
--Jeanie aka "Naomi"
ItsNotMental
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added a little EMpowerPlus back on as a multivitamin simply because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.
Naominjw- may I ask what type of doctor you are seeing? Mainstream won't pursue thyroid further than what they have been trained.
. How did you figure out progesterone ?
Thank you
The doctor who raised my older daughter's thyroid medication and switched brands... giving us the first glimpse that yes, the daughter we knew years ago was still in there... was a regular old fashioned General Practitioner who had taken some continuing medical education on the topic.
It was a "regular" endocrinologist who ran a multitude of tests on my younger daughter, but the first several endocrinologists simply would not run many (or any) tests! (see Psychiatrist vs Endocrinologist: Who is Responsible?) Even the psychiatric medications themselves can cause metabolic and endocrine problems... or eye problems, heart problems, osteoporosis, etc... but it is SO DIFFICULT to have these monitored for, let alone get baselines before our kids get on the medications!Anyway, once the younger dd got the endocrine testing, the GP put her on some of the hormones - the endocrinologist others... and ugh... it was hard to get a local endocrinologist to even understand the type of hypothyroidism the younger one had, let alone fix it. That took more years to fix even after she had it diagnosed.
Here is something their GP wrote about the younger daughter (he put her on the progesterone, too.) Childhood-onset Schizoaffective - A Medical Doctor's Perspective of the Case
Now, my younger daughter also sees an integrative type family doctor. Her insurance pays for him the same as any other doctor.
--Jeanie aka "Naomi"
ItsNotMental-The Book
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added a little EMpowerPlus back on as a multivitamin simply because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.
My ds17 and myself also have "normal" thyroid function. But both of us suffered from debilitating depression that did not go away until we were given thyroid supplementation. I had read about T-3 for treatment resistant depression, and I finally asked my pdoc about it a few years ago when no meds were helping. It really was like a miracle cure. Later I asked my ds17's pdoc if we could try it for him. She was very open to the idea and said pdocs have been using T-3 to augment psych meds for years! Well maybe not every pdoc, but it is certainly not a wild idea.
There is research going on in this area, but they really don't know all the in's and out's of how the thyroid affects the brain (yet).
--
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.