Jisp?? Abilify and other meds?

[empeg1]

Hello Jisp:

I need help. My oldest dd is really struggling. She is home with me and very unhappy. The more desperate she feels, the more anxious and volatile she becomes. There are explosions every day and often more. She misses her friends and bf and feels trapped her. She is now so triggered. The other day, my dd began to talk about wanting to die. She doesn't have a plan but the feelings are there. I am talking to her about seeing a psychiatrist, to help her with anxiety, which she recognizes and sleep- she sleeps maybe 3 to 4 hours a night. I also see depression; hence the increasing irritation. DD also has ADHD or what looks like ADHD a la FASD.

But, I want to be aware of side effects. DD has already gained about 60 pounds. She definitely will not go for a med that will lead to increased weight gain.

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[jisp]

A good psychiatrist can prescribe something that can counter the effects of increased appetite from antipsychotics. I am not sure of the situation in adults or in particular when FASD is involved.  I can tell you based on my un-scientific and anecdotal evidence that Abilify is a difficult medication to manage in children. It seems to work great at first and then over time it seems to stop working and people increase the dosage only to not get back what they initially saw when they started with the drug. Removal of Abilify in children is difficult.  But children are different and it might be a non-issue with adults.  I just don't know as I am not a doctor or a psychopharm.  

The antipsychotic that is used quite a bit with adults who have bipolar is Seroquel, and many adults find that if they take it at night it helps with sleep and with increased sleep they feel better.

But the trick is finding a GOOD psychiatrist who can work with you to do proper medication management.  All of these medications are powerful with serious side effects, that can make them sound very scary.  But if you work with a well trained and competent psychopharmacologist then they monitor their patients closely and the risks are much less because they will catch a problem before it becomes more serious.

How do you tell a good psychiatrist from a bad one? Well here are my rules?
The psychiatrist should meet with your daughter for an extended visit and do a detailed intake before prescribing anything.
He/she should do a full blood work up, EKG and if possible even an EEG before prescribing anything as powerful as an antipsychotic or anti convulsant or an SSRI
He or she should start your daughter on the smallest possible dose (even having her cut up pills if necessary).
He/she should be reachable by page initially and if any problem is observed alterations to the dosing should be made
He/she should talk to your daughter (and maybe to you as well) regularly as you are looking for the right dosing. Your daughter needs to be carefully monitored and supervised.  For example if the doctor makes an increase in the dosing of something he should arrange to touch base with your daughter 24-48 hours after she starts the new dosing.  
The doctor should not discount reports about increased irritability, excess energy, her being too happy, etc....EVERY DETAIL MATTERS. And the doctor should be asking questions to get those details from you and your daughter.

If you think your daughter is suicidal then please go to the ER. It is not worth the risk.

Meanwhile as far as weight gain....keep soda and any processed foods out of the house. Try to avoid High Fructose Corn Syrup and excess amounts of bread. That will help a lot.

[dwolen]

I know you addressed this specifically for jisp's response, so I hope you don't mind me butting in.
I thought of you and your situation today while at work. This might be helpful.
One of my long term primary care HIV patients came in. In the spring, he alarmed me by saying he could not sleep, that the sleeping pills (sertraline 200 mg and benedryl 50 mg) were not working because he could not sleep much, and he requested a stronger sleeping pill. I had him see our MH counselor, whom he told he had a noose hanging in the garage. She arranged psychiatric consultation, and now this man is taking sertraline 200 mg, paxil 40 mg, and abilify at bedtime. He feels much better because he is able to sleep, and he feels a lot calmer and able to cope with his difficult homelife, having HIV, PTSD as a veteran, and a schizophrenic adult son and being very poor in income.
He does not feel side effects from sertraline, paxil and abilify.

Lots of the psychiatric patients at the HIV clinic I work at take several anti-psychotic and SSRI medications, and sometimes long acting benzodiazapines. Most of them do really well, a lot better than they had been doing before the psychiatric medications were prescribed. Most are coping better with life.

My point is, don't be afraid of poly-pharmacy if that is what it takes to help your dd. Several psychiatric medications have a good chance of being very helpful. The first thing is to get her stabilized and feeling better.
Of course, I agree with everything J says, too.
The key word in "possible" side effects is the word "possible." Generally, side effects occur in 10-20% or less in FDA approved medications for possible serious side effects.

[empeg1]

Thank you, Dwolen. One thing, with FASD, the prevalence of side effects is much higher than in the normal population. In fact, it is very common, with atypical side effects often seen. Dosages of medication have to be much smaller as well and monitored very carefully. My dd, for instance, has experienced hallucinations, seizures and near catatonia with psychotropic medication,