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Post by ohmama on Nov 15, 2005 20:55:28 GMT -5
Gillian, If you decide to ditch the Zoloft here's an article that may help you and your doctor to see the best way to do it..... Evidence based reviews. Vol. 4, No. 9/ September 2005 "Tips to manage and prevent discontinuation syndromes" www.currentpsychiatry.com/pdf/0409/0409CP_Article2.pdf
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Post by dadhere on Nov 15, 2005 22:24:46 GMT -5
we seem to be nothing but drama, drama, drama with a few moments of calm thrown in just to tease us. Aaaaaugh! I just discovered this link on another site- our household definitely qualifies. www.visualspatial.org/what_is_a_vsl.htmWhat's good is those teaser moments let you know it at least exists!
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Post by ohmama on Nov 16, 2005 12:15:32 GMT -5
Don't miss this audio/video presentation on Bipolar!! You can register free and then click on either Flash or Slide and then the program. www.medscape.com/viewprogram/3857
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Post by 2pearl on Nov 16, 2005 20:49:06 GMT -5
Okay, confession. I've been taking wellbutrin for the last 8 weeks. Anyway,last night I was reading that little info sheet on the med that the pharmacy sticks in there (not the patient insert) and it listed "other uses" of wellbutrin as treatment for ADHD AND for depression in bipolar disorder. I have never heard of this before. Later, I'll dig through the trash to find it again for an exact quote but have any of you ever heard of it used for this before? I was under the impression that wellbutrin would be bad for BP.
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Post by irishlass on Nov 16, 2005 21:30:56 GMT -5
Thanks for those links!!!!
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Post by carina on Nov 17, 2005 5:28:25 GMT -5
Well butrin: We are trying out Edronax on three members now for ADD and also bp depression. Our pdoc said if the Edronax does not work, Welbutrin would be the next step as that was his first choice for bp depression when Lamictal and Seroquel together did not help. The Edronax is an experiment. Wellbutrin was the usual way he would follow. Up till now we had good results with Edronax since the two girls started it 3 weeks ago. Both for depression and concentration. My husband started 3 days ago and there it is to soon to notice anything. Hope this helps. Carina
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Post by ohmama on Nov 17, 2005 11:42:48 GMT -5
Pearl, Wellbutrin (Bupropion) is classified as an atypical antidepressant. Check out "Straight Talk about Psychiatric Medications for Kids, revised edition" by Dr. Timothy Wilens, page 168 for more info on this med. Just as with using stims or other AD's the mood has to be stable first and then this can be tried for the adhd symptoms. It should be watched closely for activation though. Be sure to check for drug interactions yourself and don't depend on your doctor to do this. If you are using Seroquel, there is a warning of a moderate drug interaction between Seroquel and Wellbutrin. It is defined as, "There is an increased risk that you may have a seizure while taking these medicines together.... This combination of medicines could cause moderate complications. These complications are unlikely to be life-threatening, but you should discuss this combination and any side effects with your care provider at your earliest convenience." The same interaction warning is listed when using Abilify and Wellbutrin together. Here's the link to check... www.savonhealth.com/savonhealth/record/druginteractions/default.aspx
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Post by 2pearl on Dec 1, 2005 22:47:10 GMT -5
I decided to post this follow up to the "forgot meds" thread here because it's more about meds.
DS survived the day just fine after we forgot bedtime meds (Abilify, Depakote) and then gave small doses of each in the Am along with concerta. Not only did he survive yesterday but today he was as perfect as he could ever be. It was like he wasn't on any meds at all if that makes sense, I mean he's just been great today. This now has me wondering just how significant dosing times are. Ohmama I did adjust his depakote based on our previous discussion, so this was day two of 500mg PM and 500mg AM as opposed to 1000mg PM. Yesterday only I had to split the Abilify AM/PM, it's usually only in the PM and his concerta has been the same. Could an adjustment in timing this minor have such significant effects or should I write it off as a fluke?
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Post by Mayleng on Dec 1, 2005 23:12:14 GMT -5
I think timing of meds can make a difference. But the only way to find out for sure is to keep the AM/PM split and see if it is a fluke.
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Post by dadhere on Dec 1, 2005 23:47:29 GMT -5
In my son's case, he has been on the same meds almost 2yrs. I feel if I hadn't tweaked the timing and dosing of his med combo, we would have given up on his combo before he was stable. I think it is that important to observe and chart your observations- especially when there are multiple meds involved. JMO. As for missing a dose, I wouldn't intentionally skip a dose, but it is a useful window to observe when it does happen. Darryl
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Post by 2pearl on Dec 2, 2005 0:20:33 GMT -5
OK. I do think we have plenty of room for tweaking. For now I'm continuing with the split dose of depakote and I'm going to do some research and talk to the Doc some more about how Abilify works. Hope it's not a fluke. Actually I just did yet another trial, two weeks this time, of taking him off the stimulant. I'm really glad I did this because I noted that he was having some hand trembling and a lot of spaciness, neither of these evident while on concerta. Over the two week period we lowered the abilify a bit and the trembling stopped but not the spaciness.
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Post by ohmama on Dec 2, 2005 12:16:53 GMT -5
I have noticed that the timing of when you give the dose of a mood stabilizer is almost as important as the dose itself. Even if you are giving the Depakote ER (extended release) formula, to keep it more even in the blood with noticeable mood results, I would not give all 1,000mg at the same time. Split is better for us and I feel it is easier on the child's system this way too, especially the liver.
As I mentioned to Pearl in another post, this (Depakote) is often taken at night when first started because of side effect reduction but once the child is over the initial introduction of the med it is more beneficial to give a morning and late afternoon dose. You want to have the med peak when they are awake so you can better evaluate how it is working. I'm not a doctor but I learned this through research and with alot of trial and error. I wish the psych would have told me. Unless they have a BP child, I wonder if they even know?
Now before you get too excited remember that bipolar kids cycle. This means you will not be able to truly evaluate what is going on for at least a month or more depending on how fast your child cycles. Please don't forget to keep a mood chart up to date and not rely on your memory for this. Also, as they grow the dose will need to be adjusted. It's one day at a time and stability is an elusive word. You have to learn how to ride the waves. To see true behavior results you can count on by the dose time change with Depakote, it will not usually be evident in only two days because it builds up slowly (or lessens) in the blood. Remember how long it took him to reach therapeutic level with this? There will be some fluctuation realized after a week or two. I doubt if it could be evaluated reliably in two days.
As far as the Concerta, and this applies to an SSRI also, the trembling and spaciness could be related to withdrawal. If it's working when you reintroduce it, and it sounds like it is, then that's great! If you do notice he is destabilizing after a while (a couple of months) however you would do well to try a slower withdrawal or lowering the dose and see if that helps. It's really a balancing act. At the top of this page is a referral to a site that gives information, "Tips to manage and prevent discontinuation syndromes" if you need it. Why did you stop the Concerta before?
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Post by 2pearl on Dec 4, 2005 22:12:50 GMT -5
I stopped the concerta because it makes him so quiet. He was doing fine on just the Abilify and depakote in terms of mood and hyper/impulsive symptoms. We added the concerta because he was too sleepy and we thought it might help him in school. The 18mg has been great in balancing out the abilify both in terms of keeping his appetite normal as well as sleep. I just wish there was an even lower dose.
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Post by Mayleng on Dec 5, 2005 7:36:38 GMT -5
Try Metadate Cd, it comes in 10mgs dose and lasts 8 hours. It is in the same methylphenidate family as Concerta.
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Post by 2pearl on Dec 5, 2005 8:34:19 GMT -5
Would that be a lower dose than 18mg Concerta? I know you've given me the formula at least twice but I don't trust myself to figure it out correctly. Math makes my head hurt.
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Post by Mayleng on Dec 5, 2005 9:00:17 GMT -5
10mgs Metadate CD equates to 5mgs of methlyphenidate every 4 hours (it lasts 8 hours) versus 6mgs of Concerta every 4 hours (18mgs divided by 3). But it doesn't actually release equally every 4 hours (unlike Ritalin LA). Metadate CD releases 30% initially, and 70% the rest of the time. So Metadate Cd is probably 3mgs lower than Concerta overall. Checkout this thread: millermom.proboards23.com/index.cgi?board=general&action=display&thread=1102992395
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Post by 2pearl on Dec 9, 2005 23:08:33 GMT -5
I got the presciption for the 10 mg metadate and will give it a try over xmas break.
Our psych said that even though metadate has a smoother delivery than concerta, she finds that concerta is often preferable for people with mood disorders. I thought that was interesting and thought I'd share.
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Post by Mayleng on Dec 10, 2005 9:26:00 GMT -5
That is interesting, pls let us know how it goes with the Metadate CD. Good Luck.
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Post by Beverly on Dec 10, 2005 14:43:56 GMT -5
That is interesting. My ds's former psych felt that his reaction when on Concerta was the final conclusive evidence that he had a mood disorder. But then there is a reason why he is the "former" psych.
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Post by 2pearl on Dec 10, 2005 16:41:13 GMT -5
Beverly, was your son on a mood stabilizer when he was taking Concerta? He was on depakote at one point right? There is no way my son could handle any stimulant without first being on a mood stablizer and an antipsychotic. At one point he was on just depakote and the concerta and even that was a disaster.
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Post by 2pearl on Dec 17, 2005 18:53:10 GMT -5
Just for the record, 10mg of metadate did absolutely nothing. It was like he didn't take it at all. Oh well.
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Post by Beverly on Jan 2, 2006 20:00:59 GMT -5
2pearl,
I just re-read your message above. He has been on Risperdal and Adderal since November. I want Depakote added back in because he is having "anxiety" issues and some breakthrough anger. In answer to the question, he wasn't on a mood stabilizer when he tried Concerta 5 years ago.
Did you have any success trying a higher dosage of Metadate?
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Post by 2pearl on Jan 2, 2006 21:37:58 GMT -5
Hi Beverly, 10mg metadate is too low and 20mg is too high. The 18mg concerta is just right though.
Are you planning to add the depakote back in soon? We go for a blood draw tomorrow. I'm hoping we can lower the depakote a bit.
I hope everything is going better for you. I'm relieved to have the holiday chaos over but I'm not looking forward to returning to the daily grind of homework and school issues.
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Post by Beverly on Jan 3, 2006 12:11:46 GMT -5
2pearl,
Glad to hear Concerta is working. My ds sees a nurse practitioner on Thursday since we couldn't get in to see the new Psych until 1/26. I am hoping to get her to add Depakote back, I still have 100's left but with his attitude I cannot add them back on my own-he'd end up trying to have me arrested!
This was a horrible morning, between going back to school and today is his first day of musical practice. He was in the musical last year and loved it and was looking forward to it. Suddenly last night he decided he wanted to drop out because he is afraid of forgetting his lines. Since I already wrote the non-refundable check and was soooo looking forward to him not coming home until 5pm on Tuesdays and Thursdays, my answer was no. It seems to be all anxiety related, but of course he spent the morning torturing his sister and calling me expletives. Needless to say, the Ipod he got for Christmas is mine for now. I hope your morning went better.
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Post by Gillian on Jan 3, 2006 13:03:23 GMT -5
Beverly - sorry to hear you had a rough morning. Our school starts back on Thursday and needless to say I'm not looking forward to that morning. We've been trying to get ds back on a better sleep schedule to get ready for school but, of course, he's having none of it. He is in bed as I type - you'd think his mood would be okay after a nights sleep but nooooooo. He is spitting bullets at everyone - Aaaaaaugh!
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Post by Beverly on Jan 3, 2006 15:29:02 GMT -5
I hope you don't have as rough a morning as I did. The good news is that he did actually go to musical practice. I emailed the director and asked for his assistance in relieving his anxiety.
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tickety
Full Member
If life were measured by accomplishments, most of us would die in infancy.
Posts: 44
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Post by tickety on Jan 4, 2006 15:48:59 GMT -5
My son was prescribed as of 2 weeks ago Risperdal, but there has been no change for him. He is also on Strattera for his ADHD. The Dr. stated that she thought he has Schizophrenia. I'm taking him back on Friday to find another med. Is there any relation to Bipolar and Schizophrenia? I think he needs to be on a anti-depressant. Anyone who has expereinced this, I would appreciate any comments or suggestions.
Thanks, Cyndi
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Post by 2pearl on Jan 4, 2006 16:56:55 GMT -5
Hi Tickety, Honestly I don't know much about schizophrenia. What sort of behaviour is your Dr. basing this diagnosis on? If you have any suspicions of a mood disorder ( I don't know if this holds true also for schizophrenia) I would proceed very, very cautiously with the straterra or any anti-depressants or stimulants. These medications can "kindle" bi-polar disorder. This is exactly what happened to my son so I can't urge caution enough. Here is a brief description of the "kindling effect" in relation to bipolar disorder.
The name "kindling" was chosen because the process was likened to a log fire. The log itself, while it might be suitable fuel for a fire, is very hard to set afire in the first place. But surround it by smaller, easy to light pieces of wood - kindling - and set these blazing, and soon the log itself will catch fire. Dr. Robert M. Post of the National Institute of Mental Health (USA) is credited with first applying the kindling model to bipolar disorder (NARSAD). Demitri and Janice Papolos, in their excellent book The Bipolar Child, describe this model as follows:
... initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independently of an outside stimulus), with greater and greater frequency.
Thus, to put it simply, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. This theory has been borne out by some research observations. For example, "there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode..." thus taking the kindling analogy one step further: that a fire which has spread is harder to put out (Expert Consensus, 1997).
Thus, many researchers now believe that kindling contributes to both rapid cycling and treatment-resistant bipolar disorder, and this model also is consistent with cases where cycling began with definite mood triggers, stressful or exciting events, and later became spontaneous. "
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Post by 2pearl on Jan 4, 2006 17:03:00 GMT -5
oops, I just posted before I was done.
Anyway, I think it's wise to try and treat these types of co-morbids first and let the ADHD sit on the back burner until stability is achieved. My son takes concerta but only along with depakote (mood stabilizer) and Abilify (anti-psychotic used as a MS). Figuring out the right combo can take a lot of time. Have you considered simply removing the straterra and seeing how the risperdal works on it's own? And then moving on from there?
Let us know how your appointment goes on Friday.
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tickety
Full Member
If life were measured by accomplishments, most of us would die in infancy.
Posts: 44
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Post by tickety on Jan 4, 2006 17:30:29 GMT -5
We haven’t considered discontinuing the Strattera, The Dr stated that she wanted to try the Risperdal and if it seemed to work changing his Starattera at the same time would not be helpful, then she wouldn't know which one was working. Because she believes the Stattera isn’t working. She based her diagnosis on what the teachers wrote up, the BASC test, what we have observed and talking with him. I thought he might be bi-polar but I’m not sure. He seems to have some of the symptoms but not others. It appears that he doesn’t have the Auditory and Visual hulluations but he does talk to him self often which I’m not sure if that is a symptom or not. I will let you know how the appointment goes.
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