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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by justscared on August 16, 2006, at 12:11:40
Please help!
I could really use some good info on what meds work and don't work. My son is being treated for bi-polar and has been on several different meds.
He is taking Zoloft and Resperdal. Now his doc wants to add a new med called Depakote. What does anyone know about this new med?
Has anyone been on this combo? Please help me, I am scared to give him all of these meds together.
Posted by med_empowered on August 16, 2006, at 12:39:45
In reply to Please help... Bi-Polar Son..., posted by justscared on August 16, 2006, at 12:11:40
zoloft is an ssri type antidepressant--it can help anxiety and depression, and its kind of like prozac in that it mostly works on serotonin.
Risperdal is an antipsychotic, one of the newer ones known as "atypicals". It is primarily used for schizophrenia and hallucinations, but can be used for bipolar.
Depakote is an anticonvulsant drug used for epilepsy and other seizure disorders. It is called a "mood stabilizer" b/c it seems to reduce mania and depression, although its better at reducing mania (anti-manic agent) than depression.
Personally, I think your doc should try **Just** a mood stabilizer (like depakote, trileptal, tegretol, lithium, lamictal, keppra, etc.) instead of using an antipsychotic. Antipsychotics (also known as "neuroleptics") have a number of risks associated with them that your doc needs to discuss with you. Most bipolar people can do without an antipsychotic, and they are **not** considered "first line" (first drug of choice) treatments for bipolar or other mood disorders.
Posted by justscared on August 16, 2006, at 12:58:04
In reply to Re: Please help... Bi-Polar Son..., posted by med_empowered on August 16, 2006, at 12:39:45
Thank you for the information.
My son was initially put on Trileptal. He was originally diagnosed as ADHD when he was about 5 yrs. old. Now that he is older (12) they believe he is bi-polar, not ADHD. He had a psychotic reaction to the Trileptal, resulting in a break-down. During hospitalization, they d/c'd all meds and started him on Prozac and Seroquel, which seemed to help (for a while). They just recently switched him to the zoloft and resperdal (which does not seem to be very effective).
I just feel like his doc is grasping at straws, when prescribing meds.
Posted by linkadge on August 16, 2006, at 21:25:08
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 16, 2006, at 12:58:04
When he had the psychotic reaction to trileptal, was he taking any other meds at the time?
I would have to agree with med empowered, if he has bipolar the best think would probably to just take a mood stabilizer.
I would discontinue the other meds, and perhaps try just depakote or just lithium.
Consider adding omega-3 fatty acids (with standardized EPA/DHA content) to his mix since there is growing literature of their use in bipolar unipolar and ADHD.
Try not to have him on too many drugs at once since this will likely make the prognosis worse.
Best of luck, and keep in touch.
Linkadge
Posted by Lou Pilder on August 17, 2006, at 7:45:53
In reply to Please help... Bi-Polar Son..., posted by justscared on August 16, 2006, at 12:11:40
justscared,
I saw your post about BPD in relation to your son.
I have a large body of infomation about BPD and I am a recipiant of the disorder also.
There is no cure that I know of for BPD so I deal with it by overcomming it. This means that it is like a wrestling match. I learn about the opponent, use stratagies to overcome the opponent. The opponent is still there even when I am on top and have the opponant under me. I have overcome the opponant, but the battle is still there and the opponant could get back on top.
I like emailing, so if you would like, you could email me at;
lpilder_1188@fuse.net
Lou
Posted by SLS on August 17, 2006, at 7:54:52
In reply to Please help... Bi-Polar Son..., posted by justscared on August 16, 2006, at 12:11:40
Hi.
In what ways does your son's condition present itself? How would he be without medication?
- Scott
Posted by justscared on August 17, 2006, at 8:32:07
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by SLS on August 17, 2006, at 7:54:52
> Hi.
>
> In what ways does your son's condition present itself? How would he be without medication?
>
>
> - ScottHe was originally diagnosed as ADHD, due to hyperactivity and inability to stay focused. I still think alot of the focus issues may be related to his 50% hearing loss.
He had bouts of depression after his father and I divorced, which I hoped therapy would change. As he has gotten older, he now has rage issues as well. Often becoming physically agressive, especially when teased or taunted.
When everything is going his way, he is a great kid with a wonderful personality. But as soon as something doesn't go his way, look out! I always took him off of the ADHD meds during summer breaks and he really wasn't much different, as those meds never seemed to help much.
He does not like the way he acts, and will say that he just cannot control himself. He has tried to jump out of a moving car several times and has talked of suicide during depressed states as well as during uncontrollable rages.
I could go on and on....
Posted by SLS on August 17, 2006, at 9:22:56
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 8:32:07
> > Hi.
> >
> > In what ways does your son's condition present itself? How would he be without medication?
> >
> >
> > - Scott
>
> He was originally diagnosed as ADHD, due to hyperactivity and inability to stay focused. I still think alot of the focus issues may be related to his 50% hearing loss.
>
> He had bouts of depression after his father and I divorced, which I hoped therapy would change. As he has gotten older, he now has rage issues as well. Often becoming physically agressive, especially when teased or taunted.
>
> When everything is going his way, he is a great kid with a wonderful personality. But as soon as something doesn't go his way, look out! I always took him off of the ADHD meds during summer breaks and he really wasn't much different, as those meds never seemed to help much.
>
> He does not like the way he acts, and will say that he just cannot control himself. He has tried to jump out of a moving car several times and has talked of suicide during depressed states as well as during uncontrollable rages.
>
> I could go on and on....
I can see why Trileptal was chosen. It normally has the ability to reduce mania and acts to moderate aggressive and impulsive thoughts and behavior along with behavioral dyscontrol. Actually, Tegretol has been the standard drug for this condition in the past, but Trileptal, its sister drug, is considered to have fewer side effects, although it remains to be seen if it is equally effective.The Risperdal was a decent shot. I can understand its choice as well.
How do you know when your son is depressed?
Diagnosing children is difficult. I wouldn't presume to be able to diagnose yours.
As others have suggested, it would be ideal if a single drug in the form of a mood-stabilizer were to remedy the situation. Depakote and lithium are attractive for various reasons. However, if they don't perform well, then other avenues must be explored, even if that means using antipsychotics like Zyprexa or Abilify for the mania/aggression/impulse/behavioral dyscontrol stuff. These are indeed serious drugs. However, jumping out of moving cars is a serious consequence of inadequate treatment.
- Scott
Posted by justscared on August 17, 2006, at 10:18:22
In reply to Re: Please help... Bi-Polar Son..., posted by SLS on August 17, 2006, at 9:22:56
> > > Hi.
> > >
> > > In what ways does your son's condition present itself? How would he be without medication?
> > >
> > >
> > > - Scott
> >
> > He was originally diagnosed as ADHD, due to hyperactivity and inability to stay focused. I still think alot of the focus issues may be related to his 50% hearing loss.
> >
> > He had bouts of depression after his father and I divorced, which I hoped therapy would change. As he has gotten older, he now has rage issues as well. Often becoming physically agressive, especially when teased or taunted.
> >
> > When everything is going his way, he is a great kid with a wonderful personality. But as soon as something doesn't go his way, look out! I always took him off of the ADHD meds during summer breaks and he really wasn't much different, as those meds never seemed to help much.
> >
> > He does not like the way he acts, and will say that he just cannot control himself. He has tried to jump out of a moving car several times and has talked of suicide during depressed states as well as during uncontrollable rages.
> >
> > I could go on and on....
>
>
> I can see why Trileptal was chosen. It normally has the ability to reduce mania and acts to moderate aggressive and impulsive thoughts and behavior along with behavioral dyscontrol. Actually, Tegretol has been the standard drug for this condition in the past, but Trileptal, its sister drug, is considered to have fewer side effects, although it remains to be seen if it is equally effective.
>
> The Risperdal was a decent shot. I can understand its choice as well.
>
> How do you know when your son is depressed?
>
> Diagnosing children is difficult. I wouldn't presume to be able to diagnose yours.
>
> As others have suggested, it would be ideal if a single drug in the form of a mood-stabilizer were to remedy the situation. Depakote and lithium are attractive for various reasons. However, if they don't perform well, then other avenues must be explored, even if that means using antipsychotics like Zyprexa or Abilify for the mania/aggression/impulse/behavioral dyscontrol stuff. These are indeed serious drugs. However, jumping out of moving cars is a serious consequence of inadequate treatment.
>
>
> - ScottScott-
I have been reading up on the Depakote and the potential side effects seem pretty serious. Do you have any experience with this medication?
After his bad reaction to the Trileptal, I am so afraid of new meds.As for his depression, he becomes really withdrawn and emotional. These are the times when he feels remorse for his prior manic behaviors.
Also, he has began having problems with bed wetting. Do you know if this could be a side effect of the risperdal?
Thank you so much for discussing this with me.
Teri
Posted by gardenergirl on August 17, 2006, at 10:36:02
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 10:18:22
Hi justscared,
After reading about your son's struggles, I can see why you chose your screen name. I imagine it's very scary. I'm sorry you and your family are going through this.I'm not well versed in the medications as others on this forum are. However, I'd like to encourage you to also seek psychotherapy for your son or family therapy if you are not already. A therapist can help your son develop coping skills and more adaptive behaviors.
And don't forget to take care of yourself, too. :)
Good luck,
gg
Posted by justscared on August 17, 2006, at 10:50:35
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by gardenergirl on August 17, 2006, at 10:36:02
> Hi justscared,
> After reading about your son's struggles, I can see why you chose your screen name. I imagine it's very scary. I'm sorry you and your family are going through this.
>
> I'm not well versed in the medications as others on this forum are. However, I'd like to encourage you to also seek psychotherapy for your son or family therapy if you are not already. A therapist can help your son develop coping skills and more adaptive behaviors.
>
> And don't forget to take care of yourself, too. :)
>
> Good luck,
> gg
Thank you for your response, I am so glad to have found this site! My son has a great psychotherapist, whom he feels very much at ease with. He has truly been a blessing.As for taking care of myself, I try but there is often not enough hours in the day! I also have a younger daughter, who is often jealous of the attention her brothers behavior demands. But i'm working on finding time for me.
Thanks again for your concern.
Posted by gardenergirl on August 17, 2006, at 11:27:05
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 10:50:35
You sound like a very loving parent. :)
gg
Posted by Phillipa on August 17, 2006, at 18:10:22
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by gardenergirl on August 17, 2006, at 11:27:05
I agree very loving. Love Phillipa
Posted by SLS on August 17, 2006, at 18:46:40
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 10:18:22
First of all, I discovered that there have been a few reports of nocturnal enuresis (bed wetting) associated with Risperdal. This seems more likely to occur while taking an SSRI like Zoloft.
What are your concerns regarding Depakote?
Looking at the lists of potential side effects for any of these drugs can be unnerving.
Liver toxicity is infrequent and should be screened for using routine blood tests early in treatment. The same is true of thrombocytopenia (low blood platelets).
- Scott
Posted by Racer on August 17, 2006, at 19:10:02
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 10:18:22
>
> I have been reading up on the Depakote and the potential side effects seem pretty serious. Do you have any experience with this medication?
> After his bad reaction to the Trileptal, I am so afraid of new meds.Hi, Teri --
I'm not Scott -- who really is a wonderful resource about meds, and a voice of calm reason and reassurance -- but I wanted to tell you about someone who used to post here, who took part in a drug study once. At the time, he had just stopped taking an antidepressant, and relapsed into depression. The study results said that one possible side effect was mental depression.
Just because someone experienced something doesn't mean it's related to the drug, but if it happens it must be part of the study results. I hope that's reassuring to you.
Also, if a med doesn't work out, you can stop it. Just make sure you've given it a full shot, so that you don't miss out on something good. Usually about four to six weeks for most of them.
I'm so sorry about your situation, that's got to be rough on you. Good luck.
Posted by linkadge on August 17, 2006, at 21:21:00
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by Racer on August 17, 2006, at 19:10:02
Hearing about his suicide (attempt?) and thoughts, I would personally recomend you try lithium first. It is probably better for this type of problem.
I really do recomend omega-3 though. It can really help a host of problems, many of which you have mentioned. I have been on all the meds mentioned, and have really found more long term help here.
Take Care.
Linkadge
Posted by SLS on August 17, 2006, at 21:50:07
In reply to Re: Please help... Bi-Polar Son..., posted by justscared on August 17, 2006, at 10:50:35
How variable are your son's moods over the course of a single day?
Once a depression starts, how many days will it last for?
Sorry for all of the questions.
- Scott
Posted by SLS on August 17, 2006, at 21:58:57
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by SLS on August 17, 2006, at 21:50:07
This would be a nice review to read:
--------------------------------------
J Clin Psychiatry. 2005;66 Suppl 1:18-23.Recognizing and managing bipolar disorder in children.
Wozniak J.
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, MA 02138, USA. jwozniak@partners.org
Bipolar disorder affects people of all ages, including preschool-aged children. Two major difficulties in diagnosing children with bipolar disorder are its overlap with attention-deficit/hyperactivity disorder (ADHD) and its developmentally distinct presentation from that in adults, with high rates of irritability, chronicity, and mixed states. Comorbid conditions are common in bipolar disorder and, in addition to ADHD, include depression, anxiety disorders, oppositional defiant disorder, and conduct disorder. Family studies have helped to confirm the validity of bipolar disorder in children. In terms of treatment, children do not appear to respond well to conventional mood stabilizers alone. However, using an atypical antipsychotic either alone or in addition to another mood stabilizer has shown utility in treating manic symptoms, depression in mixed states, and aggression. Amphetamine salts have been helpful in treating bipolar children with comorbid ADHD, but no data are available on treating comorbid depression in bipolar children. Because childhood-onset mania is commonly chronic rather than episodic, highly comorbid, and characterized by high rates of irritability, future clinical trials should examine the overlap of mania with other disorders in children to determine routes to accurate diagnosis and treatment.
Posted by Phillipa on August 17, 2006, at 22:10:04
In reply to Re: Please help... Bi-Polar Son..., posted by SLS on August 17, 2006, at 21:58:57
I always thought ADHD could lead to bipolar later in life? Thanks for the study. My Grandson was told he had oppositional behavior. His Great Grandfather still alive is bipolar manic and depressed very manic very depressed. He is manic in the spring and fall. So does this mean my Grandson who is almost l5 could be too? Love Phillipa
Posted by SLS on August 17, 2006, at 22:43:50
In reply to Re: Please help... Bi-Polar Son..., posted by linkadge on August 17, 2006, at 21:21:00
> Hearing about his suicide (attempt?) and thoughts, I would personally recomend you try lithium first. It is probably better for this type of problem.
You could be right. It would be an attractive solution.
Lithium and Depakote are often combined to treat an acute presentation of pediatric bipolar disorder. Once stabilized, though, one drug is sometimes discontinued. There doesn't seem to be a clear superiority of one drug over the other.
- Scott
Posted by SLS on August 17, 2006, at 22:47:44
In reply to Re: Please help... Bi-Polar Son... » SLS, posted by Phillipa on August 17, 2006, at 22:10:04
> I always thought ADHD could lead to bipolar later in life?
I don't know if ADHD leads to bipolar, but they often occur together.
> My Grandson was told he had oppositional behavior. His Great Grandfather still alive is bipolar manic and depressed very manic very depressed. He is manic in the spring and fall. So does this mean my Grandson who is almost l5 could be too?
Family history is sometimes the only reliable diagnostic clue to confirm pediatric or adolescent bipolar disorder.
- Scott
Posted by Phillipa on August 17, 2006, at 23:02:12
In reply to Re: Please help... Bi-Polar Son... » Phillipa, posted by SLS on August 17, 2006, at 22:47:44
If a first generation parent is bipolar what are the odds of their children being bipolar as my ex was told he was bipolar. He was also an alcholic. Went to AA and stopped drinking. The whole family are alcholics. Could that be a cover for bipolar. I was married to my ex when a doc precribed lithium for him and he was a different man. Then his bipolar dad found out and he quit. Love Phillipa
Posted by justscared on August 18, 2006, at 8:11:03
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by SLS on August 17, 2006, at 21:50:07
> How variable are your son's moods over the course of a single day?
His moods are extremely unpredictable. We don't have good days very often.
>
> Once a depression starts, how many days will it last for?Before he started taking the A.D.'s, he would stay in a depressed state for weeks. Now, the depression doesn't last long at all. He just has more of the anxiety (irritable) and rage.
>
> Sorry for all of the questions.No, thank you so much Scott. You are very knowledgeable.
Posted by justscared on August 18, 2006, at 8:14:35
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by Racer on August 17, 2006, at 19:10:02
My son's psych doc is adding the depakote after only 2 weeks on the zoloft and risperdal. She says I should have seen a good improvement. Should I give the current meds a longer evaluation before agreeing to add the depakote? What is your opinion?
Posted by justscared on August 18, 2006, at 8:35:52
In reply to Re: Please help... Bi-Polar Son... » justscared, posted by SLS on August 17, 2006, at 18:46:40
> First of all, I discovered that there have been a few reports of nocturnal enuresis (bed wetting) associated with Risperdal. This seems more likely to occur while taking an SSRI like Zoloft.
>
> What are your concerns regarding Depakote?
>
> Looking at the lists of potential side effects for any of these drugs can be unnerving.
>
> Liver toxicity is infrequent and should be screened for using routine blood tests early in treatment. The same is true of thrombocytopenia (low blood platelets).
>
>
> - ScottI found the following list of potential side effects during my research. Add that to the reaction he had to the Trileptal and I am a nervous wreck!
Call your doctor at once if you have any of these serious side effects:
· unexplained weakness with vomiting and confusion or fainting;
· easy bruising or bleeding, unusual weakness;
· fever, skin rash, swollen glands;
· fever, chills, body aches, flu symptoms;
· urinating less than usual;
· blood in your urine;
· hallucinations (seeing things that aren't there);
· weakness, lack of coordination;
· a red, blistering, peeling skin rash;
· extreme drowsiness;
· unusual bleeding or bruising; or
· double vision or back-and-forth movements of the eyes.
• Continue using Depakote and talk with your doctor if you have any of these less serious side effects:
· drowsiness or weakness;
· diarrhea, constipation, upset stomach;
· depression, anxiety, or other emotional changes;
· changes in your menstrual periods;
· enlarged breasts;
· tremor (shaking);
· hair loss;
· weight changes;
· a red, blistering, peeling skin rash;
· vision changes; or
· unusual or unpleasant taste in your mouth.
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