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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by frenchy on July 8, 2001, at 8:36:17
My 17 year old daughter just went into the Vol. Clinic...she's very bi-polar...and at the absolute bottom. SHe was talking about ending it all....crying out to go to the clinic. thought it was going to be a vacation away from her medling parental units....she was taking Neurotin and it made her moods bland...so she started to take herself off it, and this was at an emotional time with the loss of closeness with a boyfriend, possible new boyfriend, typicical and school pressure....SAT scores and re taking tests and work....so much to worry about she did not want to deal with it....she's a GT student, honors....little things to her were growing into giant mountains...
We love our daughter...we/I want her stable and caring about herself and family...with boosted spirits...not just manic. She was great before all this dark chat room and open-diary stuff. Her friends have dropped her. She became quasi-gothic.
How are you all coping with your children?
Have you all heard of these meds and do they work?
Will she need to be on them forever? Or can she think around the mood swings?
Please help.
Frenchy
Also....
She went in and they are trying Welbutrin , Valproate, Trazodone...and tonight after not sleeping because of the weird environonment and noise and snoring roomate...and just being scared...she was give a small dose of Riserdal .25 mgs to calm here down.She is so scared and wants to come home and just sleep.
She keeps calling and begging me to come and take here home so she can sleep...They can't release her....
Posted by SalArmy4me on July 8, 2001, at 23:27:18
In reply to My daughter just went into the Hospital, help us, posted by frenchy on July 8, 2001, at 8:36:17
Valproate (depakote) is the best thing they could possibly give her right now, according to the statistics:
KOWATCH, ROBERT A. M.D et al. Effect Size of Lithium, Divalproex Sodium, and Carbamazepine in Children and Adolescents With Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 39(6):713-720, June 2000:
"Using this same response measure with the intent-to-treat sample, the response rates to mania and mixed states were as follows: sodium divalproex, 63%; lithium, 38%; and carbamazepine, 38% ([chi]22 = 0.85, p = .60). All 3 mood stabilizers were well tolerated, and no serious adverse effects were seen.Trazodone is a novel agent not so much for depression (it is eclipsed by better, newer agents for that endeavor), but for your child's REM sleep, an important part of a child's nightly well-being. Trazodone is unique because one does not develop tolerance to it. Thus, it always works.
Risperidone is a nice selection for your child, to eliminate any ruminating feelings; and it is becoming more known widely for its efficacy in the depression phase of bipolarity, oddly enough:
Journal of Clinical Psychopharmacology; Williams & Wilkins 1998. Volume 18(1) February 1998 pp 89-91. "Adding Risperidone to Selective Serotonin Reuptake Inhibitor Improves Chronic Depression"
O'Connor, Manjia:
"Risperidone was targeted for the suicidal ideation and agitation that were superimposed on depression and anxiety. These symptoms, and disturbance in sleep and eating behavior, had responded poorly to an AD alone and with augmentation. The improvement with risperidone was rapid, and a short-duration of treatment was sufficient to control symptoms in some patients. In one patient who relapsed some months after risperidone was discontinued, a rapid response was seen again on reinstatement...The mechanism by which risperidone augmentation acts is unclear. Adding typical antipsychotics to antidepressants can help in depression with _agitated_ features, possibly by modulating the dopaminergic system, [8] but these features were absent in our patients..."Wellbutrin is world-reknowned for efficacy in bipolar disorder without causing switches to mania. http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
Hope that helps...
Posted by Sulpicia on July 9, 2001, at 22:10:00
In reply to My daughter just went into the Hospital, help us, posted by frenchy on July 8, 2001, at 8:36:17
>
>Hi--
this is a difficult time for you. I was in your shoes last summer
and sometimes it *still* scares me!The good news is that bipolar disorder is highly treatable.
The not-so-good news is that it takes some fiddling to find
the correct dosage and combination of meds -- but eventually she
will stabilize and be OK -- and have a life.It's absolutely crucial that you educate yourself about bipolar disorder.
Her pdoc will [and you make sure this happens!] educate her, but gradually
as he/she feels she is ready.
You must, really really must use only the highest quality sources of information.
I will put some links up for you later tonight -- wrong computer! argh so you can
start.Bipolar disorder is forever. If she stops taking her medication she starts to cycle.
There is good evidence that the more she cycles, the worse the cycles will become, so
it's extremely prudent to maintain good mood stability.
It's a serious disorder: untreated the mortality rate is 18-20% BUT
there are excellent medications and I communicate with lots of people with bipolar who
are doing just fine.I have to laugh at your daughter going goth -- mine [16 y/o] became a raver.
A distant memory thankfully.Back shortly with some web resources.
S.
Posted by frenchy on July 9, 2001, at 22:57:36
In reply to Re: My daughter just went into the Hospital, help us » frenchy, posted by Sulpicia on July 9, 2001, at 22:10:00
I'm starting to calm down a little.I fear that even though the meds may slow down her cycling, the boyfriend she desires to see and confide in may be very harmful to her well being and undo the therapy. She does not and has not thought clearly about her choices...it will take a lot of therapy and hopefully the "common sense" part of the therapy (the enlightenment) will straighten her out Hi, Thank you for your generous reply...
or at least put her on the correct thinking path. The meds can certainly help, but she's going to need to have some teachings in the ways of wiser guides, her therapists...we only hope she will follow the maps and charts to well being. G-d only knows why our kids don’t want to listen to us…all the kids hear is “yadda, yadda, yadda”. We are all going to a family therapist...I enjoy it. My dad past away just when we started to really know each other and talk….that was back in 1979. I wish we would have talked a lot more.I have talked to her today earlier...I told her I would call her back.... She started to panic when I did not call before 8PM.... My car sat a PEP Boys for a long time to get the tire fixed. She called me about the time I walked in. She sounded scared, but after awhile relieved that we could speak...especially about her coming home on Wednesday.
There is danger is this: The first thing she wants to do is go out and with with her boyfriend.
He is dangerous because he has no common sense...and agrees with our daughter even on the irrational thinking. I want him to stay away.
My wife will have to take off from work to stay with Brit....protect her from this fellow. I wish he had more of a brain...and could actually help her, instead of agreeing with her every whim or opinion. He is quite a wimp.... Although he cares for her like a puppy. I was once 17-18 and remember many loves that went through me and the hurt in my heart and my trembling body when I was apart from my object of my desire and lust. Do you remember such feelings? from youthful days?
I really can't discuss the extent of their relationship or how deep their desire/love goes.
All I know is they were going to take a break away from each other (the sex) during this summer...when she became so ill, she was then hospitalized.Correct me if I'm wrong...do we let her talk to her boyfriend? She has lost many of her old friends because of this fellow and the way he and she can't be separate.
Our doctors, of course, will advise us and advise Brit. But these two are addicted to each other. The boyfriend is very unstable, and has his own parents worried about him when he get depressed.
Whew-we...I've said a bunch...
Best regards,
Terry
Posted by SalArmy4me on July 10, 2001, at 1:05:35
In reply to Re: My daughter just went into the Hospital, help us, posted by frenchy on July 9, 2001, at 22:57:36
All I can say is that when the meds start working, she may have better choices in who she spends her time with.
Posted by Sulpicia on July 10, 2001, at 3:55:14
In reply to Re: My daughter just went into the Hospital, help us, posted by frenchy on July 9, 2001, at 22:57:36
> Yep. The boyfriend was our major hairshirt too. More about him in a bit -- I should mention all the things I forgot.
The odds are remote that you'll ever need any of this info but thinking and preparing can prevent a mess.
Every state has a specific legal statute that can be used to force a person to be examined by a psychiatrist and held for observation for a brief period.
Call and make an appointment with the social worker at the hospital and make sure you understand how to do this should the need arise. The process is recondite and complex -- this is good because it prevents abuse, but in an emergency it can be very difficult.
Since she was concerned about suicide, and it's very good that she was able to express herself, have a discrete look around your home.
If you have a firearm, get rid of it for now. Get rid of large bottles of tylenol, or products containing it. If you use it regularly, transfer a smaller number into another bottle.
By getting rid of these 2 you decrease the risk of trouble significantly. I might also ask her if she had a suicide plan.
I don't know what your financial position is but please make sure you have an excellent psychiatrist. Unless fate has smiled on, an HMO behavioral health system will not do. If money is tight, call the department of psychiatry at the best university affiliated teaching hospital and go thru the clinic, which has a sliding scale. Ask if they have a child fellow -- unfortunately the residency year has just begun and bipolar is NOT appropriate for a raw intern.
Another option, if her pdoc thinks it appropriate, might be a longer inpatient stay. She won't need an acute program like she has now, but there are programs that would take her for a month or so and really focus on education about her disorder, and teen life stuff.
And just in case things get hairy down the road, there is a provision of Medicaid that will give her coverage and not take parental income or assets into consideration. Ask and I'll post the info.Now to the boy -- I wish I had an intelligent answer. I can only share my experience.
Boy 1 came with the horrible crisis of last summer. Unlike your daughter, mine also had a substance abuse problem, which made bipolar *lots* of fun.
Boy 1 was heavily involved with drugs and encouraged my daughter to run away several times. And the drugs. My initial thinking, not knowing most of this, nor that he was genuinely evil, was to not press the point. There is some wisdom in this: if you take a hard stand, you risk forcing a bad choice. You must balance this with genuine danger to your daughter. In 20/20 hindsight, my 2 cents: if you see drugs/alcohol [which will destabilize a bipolar if not kill them from med interaction], if you see him encouraging behavior that is dangerous -- not sleeping, running away, not taking meds, I would come down hard. Call the police, get a restraining order, threaten to sue his parents -- anything necessary. I finally got rid of boy 1 by putting my daughter in a 6 wk treatment program and having him arrested. Fortunately he was very stupid and left evidence.
She came to realize what a dirtbag he was with little input from me.
Boy 2, about 3 months after she got out of the hospital, was merely stupid and emotionally unstable. He sounds like what you are dealing with.
It's not so dangerous to her, though I would be very concerned about his depression and judgment.
She has her hands full right now and it can be difficult for a professional to deal with depression, let alone a teen with so much to cope with. I would absolutely keep the lines of communication wide open, and I would express my concern about her having to deal with his depression. As for lacking common sense or understanding bipolar, I would tactfully express those concerns too.
Sleep is essential. Not getting into huge emotional dramas is wise in early stabilization. Paying attention and reporting symptoms of cycling is an import part of recovery -- ditto for depression.
If she lauches off into mania and he follows as a willing companion, she needs to think about this.
Clearly you must follow your instincts but my gut told me not to issue ultimatums unless I saw clear danger. He feeds her self-esteem in a way a parent cannot. You must judge the cost/benefit ratio.
My daughter got rid of boy 2 after 4 months. Boy 3 was dispatched even more quickly. Each one has been objectionable, but less and less so.
My daughter has lost most of her friends too, tho from her illness, change of school, and sobriety. She manages well on some days and not so well on others.
She was also not interested or ready for therapy when she came home. We saw our pdoc [for whom thank you higher power] weekly and kept in close touch by phone. It was not until nearly a year later that she expressed interest in talking to him alone. Now that relationship is up and running. Urge but don't demand. If family therapy is upsetting to her right now, delay it. As she stabilizes she'll be more resilient.
Do not make a huge fuss if she fouled up the school year -- there are tons of ways to get around this and she doesn't need more to fret about.
I know I haven't answered .... but it's time for me to get into the office and write. Lovely schedule I have currently. :)
I will remember to post some links for you.
And please keep in mind that she will be OK.
S.
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