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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 37. Go back in thread:
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.
Posted by SLS on August 18, 2006, at 8:40:22
In reply to Re: Please help... Bi-Polar Son... » SLS, posted by Phillipa on August 17, 2006, at 23:02:12
> If a first generation parent is bipolar what are the odds of their children being bipolar
I really don't know the statistics, but I'm sure they exist. Elliot S. Gershon, MD has done a lot of work in this area. I recall seeing one estimate of about 15% of children with one bipolar parent developing the disorder. I think it is probably higher than that. The rate of bipolar disorder in the general population is approximately 1.5%. (Some believe it to be as high as 5%).
> as my ex was told he was bipolar. He was also an alcholic. Went to AA and stopped drinking.
Thats a pretty typical MICA scenario. Fortunately, it had a positive outcome with his attaining sobriety.
> The whole family are alcholics. Could that be a cover for bipolar.
Alcoholism is more complicated than just being a symptom of bipolar disorder. There are often familial patterns of behavior that are learned or that result from repeated generational dysfunctional family dynamics such as co-dependency.
> I was married to my ex when a doc precribed lithium for him and he was a different man.
It just goes to show you that there is such a thing as a magic pill.
- Scott
Posted by linkadge on August 18, 2006, at 16:36:11
In reply to Re: Please help... Bi-Polar Son..., posted by SLS on August 17, 2006, at 22:43:50
Perhaps in terms of efficacy no, but statsically people are much more likely to take their lives on depakote than they are lithium.
http://biopsychiatry.com/litheff.htm
Who knows why, but probably due to augmentation of serotonergic function (?)
Linkadge
Posted by linkadge on August 18, 2006, at 16:41:35
In reply to Re: Please help... Bi-Polar Son... » Racer, posted by justscared on August 18, 2006, at 8:14:35
>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?
I think it is a bit unpredictable what will happen. Polypharmachology can be unpredictable.
Rage and irritability can be side effects of zoloft, but some doctors insist that it is indication of bipolar.
How much zoloft and risperidal is he taking ?
Linkadge
Posted by Racer on August 18, 2006, at 17:45:47
In reply to Re: Please help... Bi-Polar Son... » Racer, posted by justscared on August 18, 2006, at 8:14:35
> 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?
Personally, my opinion is to ask your son's psychiatrist about the possibility of swapping Paxil or Celexa for the Zoloft... They're less activating, on average, and that might reduce the whole rage thing.
Meanwhile, I think the Risperdal should probably have had a noticeable effect by now, but I'd consider it unlikely the Zoloft has kicked in yet.
Now I've got a question for ya: You mentioned your son flying into rages? (Forgive me -- I've got a cold or something, with a fever that has my pretty loopy. I can't remember much of this thread, and can't quite see rereading it right now) Was this anger problem apparent before going on the Zoloft? Or did it start with the Zoloft?
And have you noticed ANYTHING from the Risperdal? Could be there's another AP that might be more helpful. But, I'm not a doctor.
As for your son starting the depakote, I think it might be a good idea. See if it helps.
Here's something that helps me when I'm starting a new drug -- OCD, among other things, so I often freak out about potential side effects -- "If I notice any of those side effects, I can stop taking the drug."
It doesn't always help, but sometimes it does. I hope it helps you, too! Good luck.
Posted by SLS on August 18, 2006, at 19:29:17
In reply to Re: Please help... Bi-Polar Son... » SLS, posted by linkadge on August 18, 2006, at 16:36:11
> Perhaps in terms of efficacy no, but statsically people are much more likely to take their lives on depakote than they are lithium.
>
> http://biopsychiatry.com/litheff.htm
>
> Who knows why, but probably due to augmentation of serotonergic function (?)Perhaps it acts, in part, to make the person more passive. Suicide is an act that is often fueled by aggression and impulsivity.
I think which of the two drugs is ultimately to be found effective will be dependent upon which subtype of bipolar disorder is being treated. I don't know how easy this is to discern in pediatric cases. Perhaps this is why it makes sense to treat first with the combination, since each seems better suited for one of the two major subtypes.
- Scott
Posted by SLS on August 18, 2006, at 23:26:14
In reply to Re: Please help... Bi-Polar Son... » SLS, posted by justscared on August 18, 2006, at 8:35:52
Linkadge makes some very good points regarding the use of lithium. I think you should discuss with the doctor what place he feels it has in your child's treatment.
Everyone wishes they had a crystal ball. Biological psychiatry is still in its infancy, and much of its treatments still requires trial-and-error.
I don't know what to say about the Zoloft. I think this is another area where you have to question the doctor as to what was his rationale for making his treatment decision. In adults, Zoloft can be an effective treatment for pathological aggression. However, in children and adolescents, it can have the reverse effect and actually produce aggression. Perhaps this has all been taken into consideration. One thing I read on pediatric bipolar disorder advised discontinuing SSRIs immediately upon proper diagnosis. I think you are going to encounter differences of opinion regarding the use of antidepressants in this situation. I don't like to second-guess doctors, though.
It seems to me that some of the better-known doctors are using a combination of lithium and Depakote to start with and adding an atypical antipsychotic if there is an urgent need for a response or an ultimate non-response to the combination treatment.
Lithium is being looked at for treating aggression and conduct disorder in children and adolescents. It would make a neat little package to use it as monotherapy to treat everything as Linkadge suggests. Perhaps you can sit down with the doctor and develop a treatment algorithm together. Maybe you would prefer to start with lithium instead of Depakote. Of course, we don't know the doctor's rationale for choosing this drug yet. The problem with trying one mood stabilizer at a time is that one must allow each drug weeks or months to work.
The advantage to using an antipsychotic is that it is supposed to work fast. I don't know how much time it makes sense to invest in Risperdal if it is not helping. Ask the doctor where he is headed with the dosage and whether or not he feels it must be combined with a mood stabilizer to be evaluated properly. If the answer is yes, then you are pretty much committed to remaining on Risperdal until you reach therapeutic levels of lithium and/or Depakote for an adequate trial period.
I hope you are not more confused and upset now than when you started.
1. Why Zoloft?
2. Why Depakote and not lithium?
3. Combination of Depakote + lithium?
4. What maximum dosage of Risperdal?
5. How long is an adequate trial for each?
- Scott
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Dr. Bob is Robert Hsiung, MD,
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