Meds for BP/ADHD

iVillage Member
Registered: 03-25-2003
Meds for BP/ADHD
7
Wed, 04-30-2003 - 11:17am
Ok, just came back from my son's primary pdoc and he told me that the guy that is giving this evalution to him on Monday is more or less convinced that he is ADHD/Bipolar. So does anyone know how you medicate that?

The Bipolar Child says 2 things. A kid with BP should not take stimulants and that Clonodine should be avoided.

So how the heck do you medicate a kid with both. Respirdol and ritalin and clonodine def are not doing the job right now.

Elspeth

iVillage Member
Registered: 04-17-2003
Wed, 04-30-2003 - 12:26pm
I might be in similar boat myself... we are currently on Strattera but to be honest while it helps some it's not as great w/the concentration as the Adderall was but the tantrums/outbursts aren't as frequent - or they weren't before Spring Break - I am gonna be talking to the doc (shrink) on Friday about bipolar for Deven.... curious what your doc will say about things.... {{HUGS}}

Angel

Angel - Tired Momma to the Tagteam of Destruction and Disaster affectionately known as Deven (6/27/97), Dilen (10/20/99) and Ethen (4/14/05)  http://tagteam_of_2_jerzydevils.blogspot.com/

iVillage Member
Registered: 03-26-2003
Wed, 04-30-2003 - 1:33pm
YIKES!! I just had the VERY same conversation with my son's PED: That the Strattera is "okay" as far as impulse/melt-down stuff (recent events notwithstanding) but that it is not as good as Ritalin in terms of focus/concentration issues. (Ritalin et al are now "off the table" because my son developed a facial tic.) Interesting that you are making the same observation ... also interesting that the Strattera literature seems to emphasize impulsivity and doesn't mention much about focus/concentration. Hmmm, ya think we are not alone here??

DS' PED agreed that ds needs further evaluation, and seems to agree with me that bipolar disorder is something that needs to be looked at. So, I have some telephone numbers for p-docs that I need to start calling as soon as I finish typing this post. Unfortunately, local child psychiatrists are apparently much harder to come by than psychologists 'round here (you can't shake a stick without hitting a psychologist's office ... and law practices are so numerous it's *ridiculous*!) -- so, I have the phone numbers of three metro-area hospitals. I guess we are somewhat blessed to be living within a reasonable distance of all of these resources - two are very well-known and well-regarded teaching hospitals, and the third is a dedicated psych hospital. But I have a huge knot in the pit of my stomach at just the *thought* of making these phone calls. Nonetheless, I now (well, after I finish gobbling down my Chic-Fil-A lunch) have to start making phone calls to try to get an appt for ds. His PED told me that if they try to tell me they can't give him anything for six months, to let him know and he will try to see what he can do. Unfortunately, our PED practice doesn't have any alliances with any child psychiatry practices, so I am kind of doing this "blind" if you know what I mean.

PED assured me (as I swallowed back tears) that bipolar disorder can be very effectively treated, and that it is treatable in tandem with ADD. Why am I so much more ... freaked out by a possible bipolar dx than I was about the ADD thing? :o( ~ ruth

Avatar for kathy_in_ga
iVillage Member
Registered: 03-26-2003
Wed, 04-30-2003 - 2:13pm
OK here goes (We have the same problem by the way). First they try a mood stabilizer, Depakote, Trileptal, Neurontin...(they may have different names in Canada). Then they can also add an anti psychotic, Risperdal, seroquel... They may take him off a stimulant, we only tried that this past Dec - Feb with no help. I have heard Strattera can help some BP kids, but it is not good for them to be on any type of antidepressant. ALWAYS REMEMBER; each child reacts to meds differently. What works for one may not work for another. The biggest thing you need is a mood stabilizer, sometimes two are needed. Joiner takes Depakote, Seroquek and adderall XR, but we are having problems again. Once you get the right combo things are easier. I know of a few kids who are on the right combo, needing slight increases every once in a while, and they are doing wonderfully. One kid I never thought could be stable, but he is.

Good luck with your appointment on Mon.

iVillage Member
Registered: 04-15-2003
Wed, 04-30-2003 - 5:15pm
Hi Elspeth and Ruth,

I know you don't feel very lucky right now, but in a way you are. A lot of bipolar + ADHD kids are misdiagnosed and medicated incorrectly through their teens and beyond, with sometimes devastating consequences. There is even talk now that if bp is treated early enough, it may even prevent fullblown manifestation of the disorder, who knows. It will at the very least save you some pain.

Elspeth, you mentioned you already had The Bipolar Child (by Papolos), and Ruth, if you don't, that's probably the best starting place. I'd also strongly recommend the bpkids.org (Child and Adolescent Bipolar Foundation) site. They have a lot of additional information -- research, interviews, etc. in their Learning Center. They have some online support groups as well that are very helpful. There are several for very young kids, and Elspeth, I think there's even a very young bpkids Canada online support group. If your kids are bp + ADHD, those resources can save you years of aggravation and wasted time, energy, and money.

Generally, bp kids are treated first with mood stabilizers, and for many it takes 2. Often an antipsychotic is added to control aggression and/or hallucinations. Recently, some have begun using monotherapy with antipsychotics. Ruth, re what your ped said about treating bp + ADHD, well, the good news is that ADHD-type behavior is often misdiagnosed mania in these kids with dual diagnoses, and it can resolve with a mood stabilizer. The not so good news is that if it truly is residual ADHD -- as, I think, in my ds's case (he's 5) -- the ADHD component is tricky to treat.

But, there is a lot of hope. I can tell you we began this journey over a year ago, and life was pretty stressful back then. But our son is now mood stable, and that's a huge improvement! Now we're trying to find answers for the ADHD. But that is actually much easier for us to live with than the mood problems were.

So, (((hugs))) to you both, and good luck with the evaluations.

Melissa

iVillage Member
Registered: 03-26-2003
Wed, 04-30-2003 - 5:36pm
Thanks so much for the encouraging words, Melissa!! It's really heartening to hear the experiences of someone who is further along this journey than we are!! Thanks, too, for the book info and for the links to bipolar info that were posted (I *think* it was you who posted them) -- I have a LOT of reading to keep me busy, I think! ;o)

Oh, with regard "mania being masked as ADHD": DS is ADD rather than ADHD - so, I'm not sure how this will affect either other diagnoses or the course of his therapy. The ADD dx was "confirmed" through an IQ test (the Wechsler III)administered by a private psychologist, and was pretty evident when looking at the skew between his verbal and performance scores (though ds still "lands" pretty firmly in the gifted bucket, even when the two scores are averaged).

Latest frustration: I called the three practices my PED recommended (at three large facilities in our metro area). One has recently discontinued all outpatient services and now only provides inpatient services; one has no doctors who both accept our insurance plan and who are accepting new patients who have our plan (which is, might I add, a PPO from a MAJOR provider, and this is at a very large teaching hospital, so I have no idea what is up with that); and, the third has not returned either of two v-mail messages I have left. I foresee some major headbanging (mine) ahead.

Sorry to have rambled (I seem to do that a lot on this board!) ... thanks so much again for your kindness. I'll keep you posted! ~ ruth

Avatar for kathy_in_ga
iVillage Member
Registered: 03-26-2003
Wed, 04-30-2003 - 6:11pm
Hi Ruth,

Go to bpkids.org they have a list of psych docs & may have one in your area. Just poston the main message board & someone may know of one in your area. Also, look at this sight, all you have to do it enter your info & see if there is a psych doc in your area. The list is made up from people who recomend the doc. It was easier for me to just enter my state. I found a few who I didn't know existed.

http://www.dbsalliance.org/referral/search.asp

iVillage Member
Registered: 03-26-2003
Wed, 04-30-2003 - 6:55pm
Oh!!!! Thank you, thank you, thank you!!!!!!! Just checked your link out briefly, and it looks as though it will be a HUGE help!! I feel a little less hopeless right now. I am off to investigate. You ROCK, Kathy! {{{hugs}}} ~ ruth