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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by cherdi814 on January 1, 2004, at 20:12:35
Hi everyone-
I am a single Mom trying to cope with not one, but two children with depressive problems. My greatest concern is with my youngest daughter who has been diagnosed with Oppositional Defiance Disorder, Bi-Polar, borderline personality and chronic depression. The Bi Polar was diagnosed two years ago and the ODD recently. She has been taking Effexor, Topamaxx and recently Prozac was added. As recent as 3 months ago and continuing, she has had panic and rage attacks, an elevation in aggressive behaviors, paranoia, and almost delusional thinking. It has become almost a psychotic behavior problem! She was placed in an alternative school (8th grade) several weeks ago which seems to aggravate her even more often. I am now the enemy and she can be so amazingly cruel at times...and the times are many. I feel I have lost my daughter and find myself trying to defend even her medication. My question is now, can the medication actually be contributing to her escalated aggressiveness? The doctor took her off the effexor, yesterday and now has raised the topamaxx to 200 mg/day and the prozac to 40 mg/day. Can anyone tell me if this will work on a 14 year-old child? Thanks-
Posted by dragonfly25 on January 1, 2004, at 22:42:11
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
Hi
i am not an expert, but i hate to hear about kids being medicated. it can do all sorts of things to thier mood. any of those drugs could be doing it, so could the environment change at school. she may need them, but 3 different medications is alot. Could you go for a second opinion about the meds?
just a comment about the school she is in now (i may be speaking out of turn)- but if you notice that she has become worse i might reconsider. i think kids are very susceptible to pick up other kids problems b/c that is what they are exposed to. just watch out for any sign of improvement, if you don't see any reassess.
good luck
dragonfly
Posted by HappyGirl on January 1, 2004, at 23:53:28
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
Hi:
The med. combo. your daughter is on might be problematic to her behaviour. In Bipolar, whether adolescent/adult, needs a good mood stabilizer such as Depakote, Lithium and more to search. Topamax is M.S., however a sort one of the weakest M.S. among others, even some of Bps taking as 'add-on' Mood stabilizer, because this med. is good for 'weight-loss' property, unlile most M.S. Then, it seems to need more conventional M.S., such as Depakote, Lithium and more to say. Lamical is a good med., both M.S. and Dep. effects and a good reputation among Bps.
Rage/anger is major and annoying problem among Bps., for this, her pdoc. should put her on more aggressive med. regimen. In my knowledge along with personal experience, atypical psycho-med. such as Zyprexa, Risperdal and Seroquel is one of the best meds. for rageous form of Bp, called 'dysphoric mania.'
Also, Bipolar and BPD is very similar in regard to its characteristics that in turn has similar rx. Even, just one name, Bipolar is enough, ... without adding BPD. Because, Bipolar and BPD is practically same/similar M.I. Even ODD might be a part of her Bipolar, if not severe form.Unlike regular form of depression without compexity, Bipolar is fairly complex in regard to dx and rx. Besides this, your daughter going through transitional period from childhood to adulthood that might bring more psychological problem on her daily life, especially among her peers/school.
In my suggestion, not only med. regimen also try to get 'psycho-therapy/counselling' to ease her emotional tension and stress, because 'stress' is #1 enemy once dealing with M.I., especially Bipolar.
H.G.
Posted by Elle2021 on January 2, 2004, at 8:42:24
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
Perhaps you should get a second opinion. It isn't likely that a child that young will get a Borderline diagnosis. It's sad to see children being medicated like that.
Elle
Posted by cherdi814 on January 2, 2004, at 11:56:33
In reply to Re: Any advice about meds?, posted by dragonfly25 on January 1, 2004, at 22:42:11
Hi Dragonfly,
Thanks for responding. I hate the fact that my daughter is also on 3 meds...she is now coming down to 2 and I am concerned still that it will be enough. Yes, she does mimic others' behavior and mainly to "fit in" with her peers. It is a difficult situation. Please pray for us...thanks-
Cheryl
Posted by cherdi814 on January 2, 2004, at 12:05:14
In reply to Re: Any advice about meds?, posted by HappyGirl on January 1, 2004, at 23:53:28
Hello Happy Girl,
Thank you for responding. My daughter has been ODD since 2 yrs. old. ODD is often co-morbid and the BiPolar equates for the comorbidity disorder. It is turning into borderline personality, as many who have ODD develop a personality disorder from the ODD either by itself or with it. My aim is to keep the ODD from becoming a conduct disorder...it's a huge job. With the latest changes, she is dropping to an increase in both the Prozac and the Topamaxx. She has been on Zyprexa, Depakote and Goeodan in the past...they doped her up so badly she could only sleep. Although her personality was so calm and she was wonderful to be around, the Geodan and Risperdal kept her from functioning normally and was a problem. I agree she needs more aggressive medication and therapy. She is starting with a new Psyc. next month and hopefully will address some of the probs along with a new therapist. Please pray for us. Thanks-
Cheryl
Posted by cherdi814 on January 2, 2004, at 12:12:05
In reply to Re: Any advice about meds? » cherdi814, posted by Elle2021 on January 2, 2004, at 8:42:24
Hi Elle,
Thanks for responding. We have had at least 6 opinions so far and all concur with the diagnoses. Apparently the ODD is severe enough that Borderline personality is one of the developmental disorders. I wrote more on that to Happy Girl...I hate the fact that my daughter has to take medication, however her behavior is such that the entire family is in counseling and my health is becoming at risk from the stress of daily life with her. Although many options are available, I cannot bring myself to imagine them and continue to try my best with any knowledge available to incorporate my daughter into being a healthy and loving member of the family. Needless to say, it has already taken its toll and continues to do so, daily. I am placing a lot of faith in God that he can make a big difference with her. Please pray for us all...
thanks-
Cheryl
Posted by Ilene on January 2, 2004, at 12:42:33
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
> Hi everyone-
> I am a single Mom trying to cope with not one, but two children with depressive problems. My greatest concern is with my youngest daughter who has been diagnosed with Oppositional Defiance Disorder, Bi-Polar, borderline personality and chronic depression. The Bi Polar was diagnosed two years ago and the ODD recently. She has been taking Effexor, Topamaxx and recently Prozac was added. As recent as 3 months ago and continuing, she has had panic and rage attacks, an elevation in aggressive behaviors, paranoia, and almost delusional thinking. It has become almost a psychotic behavior problem! She was placed in an alternative school (8th grade) several weeks ago which seems to aggravate her even more often. I am now the enemy and she can be so amazingly cruel at times...and the times are many. I feel I have lost my daughter and find myself trying to defend even her medication. My question is now, can the medication actually be contributing to her escalated aggressiveness? The doctor took her off the effexor, yesterday and now has raised the topamaxx to 200 mg/day and the prozac to 40 mg/day. Can anyone tell me if this will work on a 14 year-old child? Thanks-
I'm sorry you are in such an unenviable situation. Fourteen is a tough age a for a girl, even one who doesn't have a psychiatric disorder. It's hard not to let them push your buttons, but try to remember that a even a "normal" teenager is a self-centered creature who has little empathy for those around her, especially mom, the person who tries to run her life.I do't know how these medications work in children, but Prozac triggered psychotic depression in a (adult) cyberfriend. Also, ADs can trigger mania in bipolar disorder. Especially as this is the newest med I'd ask the pdoc to take her off it.
Did she go off Effexor cold turkey? Withdrawal can be wicked, even when the dosage is tapered.
I would definitely keep her medicated. Articles I've read about depression and bipolar disorder say that the longer the disease is untreated the worse it is likely to become. I wish my depression had been diagnosed and treated when I was still a kid.
Some drugs for BP and epilepsy can help anxiety. I don't know if Topamax is one of them. I take Neurontin (an anti-epileptic that the manufacturer was promoting off-label for BP) to help me sleep. The pdoc thinks it should help the anxiety although I haven't noticed anything. I also take Klonopin, but not on a regular basis. I don't know if it or related drugs (e.g. Ativan, Xanax) are prescribed for children.
Good luck, and please don't listen to people who tell you your daughter shouldn't be on drugs. These are medicines, and she needs them.
Ilene
Posted by HappyGirl on January 2, 2004, at 15:00:37
In reply to Re: Any advice about meds?, posted by cherdi814 on January 2, 2004, at 12:05:14
Hi:
Hearing your daughter dxed ODD at such tender age, just 2, I'm quite surprised. However, with a good knowledge accummulated in years since, you don't need others' suggestion. However, I just wonder *how much Zyprexa* she's been on. Because, when I was 10mg., my Bp depression got so bad. Then, lower-down to 5 mg. that exactly the chemical of my brain needs.
Also, your daughter might be 'med. resistence' to find med. combo. that is due to many years' use of psycho. med. or simply her system to not able to adapt to foreign stuff.
In my knowledge, probably not many, ... however some of Bps are med. resistence. For this, some Bps even need to make a trip to pdoc.-authority who is more than psychiatrist, ... (the name for this, I just can not remember tho'.) Then, there is still 'reliable source' for your family to look for. However, there might be 'time-consuming job' to do. In the meantime, you may contact her school(alternative one?) to get some accommodation for your daughter.
H.G.
Posted by sadmom on January 2, 2004, at 15:26:56
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
I have two children who have bipolar disorder. The best type of med to stop the anger and rages are anti-psychotics. Risperdal Seroquel Geodon Abilify Zyprexa.
I also recommend going to http://www.cabf.org and join one of their mailing lists for support. Other parents there are very knowledgable about children and meds and school problems.
Posted by cherdi814 on January 2, 2004, at 17:04:58
In reply to Re: Any advice about meds?, posted by sadmom on January 2, 2004, at 15:26:56
Hi sadmom,
Thank you for responding...I have been overwhelmed with emails since my post, but it really is a relief to know that many posting share some of the problems I am experiencing right now. I only wish my daughter was simply Bipolar...unfortunately the probs encountered are that until other disorders she has are under control, it is difficult to know which disorder needs what. Thanks for your input, though, and please pray for us.
thanks,
Cheryl
Posted by cherdi814 on January 2, 2004, at 17:08:03
In reply to Re: Any advice about meds?/To: HappyGirl, posted by HappyGirl on January 2, 2004, at 15:00:37
Hi Happy Girl,
One of the major probs she encountered on the Zyprexa was the inability to think coherently and the amount of weight gain she had. That was the main reason she was taken off it and put on Topamaxx. I am beginning to think a fresh start to cleanse her body and just one medication may work at this point. God knows we have tried everything else...
thanks,
Cheryl
Posted by cherdi814 on January 2, 2004, at 17:15:44
In reply to Re: Any advice about meds?, posted by Ilene on January 2, 2004, at 12:42:33
Thanks Ilene,
There does not seem to be much understanding with adolescent psychiatric conditions, even amongst my friends and family. My ex-husband took over 2 years to admit my daughter needed counseling and meds...everyone seems to think I just want a child who is perfect and behaves perfectly. They really mean well, but a couple of friends just talked to me for 2 hours today about the meds being the reason my daughter behaves the way she does...I wish! From all I have read in the responses to my post, a reevaluation of my daughter's medications seems in order. I was ready to throw in the towel on any medication just to prove my point to others, however I am unwilling to jeopardize her health to prove a point. I am weaning her off the Effexor...she is bound to have problems, but I am hoping my support for her will help. Thanks for writing...I appreciate the support of everyone. This is such a difficult situation to deal with...
Cheryl
Posted by brussell on January 2, 2004, at 21:50:52
In reply to Any advice about meds?, posted by cherdi814 on January 1, 2004, at 20:12:35
Hello,
I'm sorry you have to deal with such difficult choices.
I have a couple concerns:
Your daughter's biggest problem right now seem to be with the manic pole of her condition (rage, psychotic symptoms).
People with BPI can be pushed into a manic state by conventional antidepressants. It is possible that the Effexor and Prozac are contributing to the problem.
I think your daughter needs a real anti-manic agent, like lithium or Depakote. If you can control the mania you can probably get a handle on your daughter's behavior problems.
The medications you have listed do not sound like good choices for Bipolar I disorder. I think you need to consult with a psychiatrist (with a child/adolescent specialty if at all possible) who has experience treating Bipolar I.
Best of luck to you and your daughter.
P.S. If you can control the mania with lithium or Depakote, your daughter may need antipsychotics only occasionally, if at all.
Posted by cherdi814 on January 3, 2004, at 14:19:23
In reply to Re: Any advice about meds?, posted by brussell on January 2, 2004, at 21:50:52
Hi brussel-
Thanks for responding. The meds and choices seem to take so long to initiate and be watched to see if they work. She has taken Depakote before...it worked at first and then seemed like she got so depressed. It has been so much trial and error involved and time consuming. Plus I hate the entire idea of having my daughter on so many drugs. We are headed to a new therapist and Pdoc...please keep us in your prayers.
thanks,
Cheryl
Posted by Utopia on January 3, 2004, at 16:50:06
In reply to Re: Any advice about meds?, posted by HappyGirl on January 1, 2004, at 23:53:28
I agree with Dragonfly. Cildren with such difficulut to treat diorders e.g. OOD are extremely delicate issues to take on and pdocs do do grudgingly.
Here you have a young mind who has a problem, you pump into it chemicals which could effect the developmental process of the child' brain.
Very scary.
Posted by Ilene on January 4, 2004, at 17:57:35
In reply to Re: Any advice about meds?, posted by cherdi814 on January 2, 2004, at 17:15:44
> Thanks Ilene,
> There does not seem to be much understanding with adolescent psychiatric conditions, even amongst my friends and family. My ex-husband took over 2 years to admit my daughter needed counseling and meds...everyone seems to think I just want a child who is perfect and behaves perfectly. They really mean well, but a couple of friends just talked to me for 2 hours today about the meds being the reason my daughter behaves the way she does...I wish! From all I have read in the responses to my post, a reevaluation of my daughter's medications seems in order. I was ready to throw in the towel on any medication just to prove my point to others, however I am unwilling to jeopardize her health to prove a point. I am weaning her off the Effexor...she is bound to have problems, but I am hoping my support for her will help. Thanks for writing...I appreciate the support of everyone. This is such a difficult situation to deal with...
> Cheryl
I'm glad you are re-evaluating your daughter's meds. Have you considered a consultation with a psychpharmacologist at a university medical school?Dealing with well-meaning friends and relatives can be *so* frustrating, because they often think they know so much more than they do. For a while I was relatively forthcoming about my problems with depression, then I changed tactics because what depression means to me (it's ruined my life) isn't what it means to most people (temporary low mood). That was when I had more of a life, too.
And how would you friends know that the drugs were causing your daughter's behavior? First-hand experience? ggrrrr
Please read some of the threads about Effexor withdrawal if you haven't done so already. I was slowly weaned off it, and about 24 hours after my last dose was hit with dizziness and electric-shock-like sensations. I spent 3 days in bed, lying as motionless as possible, as that was the only way to avoid the "shocks". My pdoc says there are drugs you can take to help tide you over. I should have called her, but I was so mad about being put on a drug I didn't really want to try, have strange SEs, and then suffer through the misery of getting off it that I didn't want any *more*drugs.
Please keep posting.
Ilene
Posted by brussell on January 4, 2004, at 18:09:02
In reply to Re: Any advice about meds? » brussell, posted by cherdi814 on January 3, 2004, at 14:19:23
Good luck with your new doctor.
I wanted to ask if you had tried lithium. It often works well for people who respond badly to Depakote. I know personally of one girl who had a terrible time with Depakote who is now taking lithium and doing fine at a college-prep school.
Hopefully, if you can get the mania under control with a mood stabilizer your daughter might need few or no other drugs.
Posted by Ilene on January 4, 2004, at 18:45:52
In reply to agreement with Dragonfly, posted by Utopia on January 3, 2004, at 16:50:06
> I agree with Dragonfly. Cildren with such difficulut to treat diorders e.g. OOD are extremely delicate issues to take on and pdocs do do grudgingly.
>
> Here you have a young mind who has a problem, you pump into it chemicals which could effect the developmental process of the child' brain.
>
> Very scary.
On the other hand, the chemicals may help the child's brain develop normally. Modern imaging techniques show that people with mental illness do not have normal brains. Pdocs used to believe that children could not suffer from depression or bipolar disorder; now we know that's not true, so why withhold treatment on the basis of age?Ilene
This is the end of the thread.
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