Psycho-Babble Medication Thread 4378

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Meds For Bipolar, CD and ADHD Son

Posted by Karen on April 3, 1999, at 20:59:31

We have a fifteen year old son that was diagnosed at age four years with ADHD. Adopted by us as a baby, we do have some biological information on his birth parents. At age nine years, dsythimia (sic) was added to the diagnosis. At age ten years, he was placed in a day school for conduct disordered children as the school district did not know what else to do for him as they had no ADHD program. He struggled in this alternative school setting while he continued on various trials of Ritalin, Dexedrine and Imipramine. The Imipramine trial resulted in his first psych hospitalization to titrate meds after he ran in front of a school bus in a suicide attempt. He left the hospital on Lithium and 5 mg of Ritalin, with Clonidine being started two weeks later. This was the first time we heard the word: Bipolar. Our son was aggressive while on the Imipramine. The Clonidine put him to sleep, but he could not function. We spent the summer desperate to locate medication to stablize him so that he might return to school in the fall with a better chance for success.
Dexedrine was tried and it made him aggitated at even a low dose. As school started he was on Buspar and a small portion of a Clonidine pill. The school would not permit the portion of the pill to be administered at school and so this med combo was abandoned. We returned to a low dose of Ritalin and waited until spring break hoping to see his doctor again in an attempt to try something else. Shortly after spring break our son, at the age of 13 years was raped by a 15 year old boy. We did not know this until the fact came out during therapy after our son had been placed in a residential setting because of four serious suicide attempts during a monthly span of three months following the rape. In the residential setting our son did thrive for approximately nine months and was ready to transfer to cottage downtown and a regular high school before coming home. In July of that year, a doctor change at the residential facility resulted in our son being confused with another student and had all of his medications stopped! We did not know this and of course were not notified as it was a mistake from the beginning. The few weeks left of the summer did not permit the newest doctor at the facility to begin new meds and titrat them properly and our son became extremely depressed and aggitated as he viewed what he considered to be his "big chance" go down the drain. He also became further depressed and convinced that he had once again failed. Because our son was on
probation due to an incident of naivete and impulsiveness his PO found out that our son was not progressing at his program and order us back to court on 12/4/98. What was to be just a "heads up" to get our son back on track and help him snap out of his
defeatist additude turned into a possible placement in a correction facility when our son became billigerant and verbally aggressive to staff as he was informed of needing to go to court for "failure to progress in treatment" as was dictated in his conditions for parole. We had been lucky to have our son placed in the residential setting, as this had been part of the plea bargain the DA arranged for our son when he agreed to testify against the adult that actually committed the crime. During the trial our son was also hospitalized for his most serious suicide attempt and it was obvious to anyone that interviewed him that the mental problems he was facing were exasperated by the stress of the adult's
trial and having to testify. Our son wanted help and knew if he did well he would get his chance at treatment at a residential setting. This fact made it all the more difficult to help our son work through the disappointment of the medication fiasco and his inability to transfer to the halfway cottage in the fall of 1998. Because of the verbal abuse our son was giving staff and his potential for escalation
the residential staff informed our son's PO that he would no longer be welcome back at the residential facility! We were not informed of this development until 36 hours prior to our court date. There was no chance that our son could come home in light of his suicide ideation and need for continued treatment and we knew that he would deteriorate in a prison setting. We searched chat groups, support groups and such for disabled, mentally ill and at risk youth websites. We were able to locate a turnaround outdoor therapuetic camp for our son. We spoke with the director, a former Los Angeles Probation Officer, and he agreed to contact the court and judge on our behalf to indicate that our son would be accepted into his program. Our lawyer spoke with the judge and our son's PO and things were worked out prior to ever walking into the court room. Our suggestion was accepted by the judge. Cost of the program was just over $17,000. and with attorney fees, our outlay to keep our ADHD-Bipolar son out of the state pen was just over $20,000. We thanked God that we were able to close out various investments and borrow from family and friends on a short term to bring the cash together, as we had to pay when we delivered our son to the program, just seven hours after leaving the courtroom. Most clients in the program are there from approximately 14 weeks to 18 weeks. Our son was just 4 1/2 weeks shy of his 14 week graduation and on target for completing the program when it was decided that it might be nice to wean our son from his many medications that he was taking as a result of being at the residential facility. None were really working very well as reported to us by residential staff and the result of the poorly laid out med regimen was that we had ended up in court and at the turnaround camp in an attempt to stabilize our son and get some behavior training accomplished. It is our hope that our son can leave the turnaround camp and return home with the school district providing day treatment. Meds at the time of admission to the turnaround camp: AM/Transadone 25 mg, Buspar 10 mg,
Adderall 10 mg, Zoloft 50 mg, Depakote 250 mg and
Visoril 25 mg. Noon/Buspar 10 mg, Zoloft 50 mg, Adderall 10 mg and Visotril 25 mg. Night/Buspar
50 mg, Transadone 50 mg and Depakote 250 mg When the meds ran out at the therapuetic turnaround camp, the refills we obtained and mailed to the camp were not sent out to the field. Our son therefore stopped all meds, stone cold. He was not on any meds for two weeks. At that time we began to get reports back from the field staff that he was increasingly uncooperative, could not stay focused on even the simplest task, etc. A psychiatrist was located in the city near the turnaround camp headquarters and our son was taken by staff to the doctor. Because our son had started to urniate on himself at night when his meds were stopped, it was decided that a trial of Imimpramine might work as it would address the bedwetting problem as well. Ten days into the trail of the Imipramine and our son was ballistic. He paced constantly, was aggitated and could not pysically calm down. He was verbally aggressive at first, asking to be left alone so that he might get himself under control. Because the staff ratio is three to one and the camp is 3 1/2 hours from the town by Jeep, it was not deemed wise to permit our son to be alone in this mountainous desert area. A staff member was assigned to be his one on one and the two of them moved away from the others in the camp. Our son began to push his one on one staff person away from him and then threw a stick at him when he would not stay away from him. Our son was taken to the doctor in town once again and the Imipramine was discontinued and Nuerontin was started, 300 mg, three times a day. Unknown to staff our son was not swallowing the pills and one week later we were contacted to come and get our son as there was no adolescent pysch ward in the town near the camp, all that could be provided was a padded cell! Our son is home now after a one week stay at a psych ward in a town near us. The results of this stay were just more of the same. But with the ADHD and the Bipolar the new doctor has now added Conduct Disorder, especially in light of the fact that our son deliberately defied his doctor and the camp staff and was noncompliant with his meds. While at the hospital our son developed a temperature of 102 degrees and sustained that temp for three days. Robatussin and Tylenol were given. Upon discharge our son also had a horrible chest cough. We took him to an Urgency Clinic near our home and found out that he was so dehydrated he needed two and one half IV bottles of fluid to stabilize him. Chest xrays revealved pnemonia (sic) and he is now permitted to stay home one week until 4/10/99 to get the pnemonia under control. The hospital doctor has started our son on 5 mg of Zyprexa at night to control his anger, rage, temper whatever you wish to call it. As yet, we have seen no results from this med. We are deeply concerned about sending our son back to the turnaround camp without something to address his ADHD as of course the staff are trying to teach new ways of handling anger and problem solving....very hard to absorb if one can not sustain attention! What might be added to the Zyprexa to help with the ADHD? At the staffing prior to leaving the hospital, the doctor had been very open to trials of various drugs and combinations to alleviate the symptoms our son is experiencing. The doctor feels certain that the Zyprexa will keep our son calm and without rages or temper tantrums as he finishes up the program. Would Wellbutrin be of any use for the ADHD? The Adderall we have found out is too close in chemical composition to Dexedrine, which our son does not tolerate well. What about Cylert? Is the Zyprexa dose of 5 mg once a day therapuetic enough?`

Many thanks to anyone that desires to respon to my post. I have never done this before and was so very thankful to come upon your wonderful webiste. To each and every parent, guardian, doctor or health professional that comes to this website I wish you energy to sustain you as you attempt to help your loved one and/or assist someone who is trying to get help for their loved one that suffers from these terrible disorders. Sometimes I have seen where just one advocate can make a difference in our loved one's life just by offering that one piece of advice, a bit of hope and/or encouragement, etc. Never give up the fight, each one of us is precious and deserves to have the best quality of life possible. Good luck to one and all.

 

Re: Meds For Bipolar, CD and ADHD Son

Posted by Matt on April 5, 1999, at 3:11:41

In reply to Meds For Bipolar, CD and ADHD Son, posted by Karen on April 3, 1999, at 20:59:31

Karen,

I'm really sorry to hear about all you've been through--I can't imagine what it all must be like, both for your family and for your son.

I don't know tons about ADHD, but I know a bit. So take this with a grain
of salt. Cylert is one possibility, certainly Another is an
activating antidepressant like Wellbutrin or a less sedating TCA
(nortriptyline or perhaps protriptyline). Wellbutrin (which is sometimes
used for ADHD) would seem a better choice, because of your son's prior
experience with Imimpramine. Wellbutrin also would be a good choice for
the depression side of the bipolar.

Zyprexia 2.5mg is used in more than a few patients for relief of anxiety,
unclear thinking, etc.. 10mg is a normal dose for antipsychotic use, though anywhere from
5-20mg is used for this purpose. If the doc thinks that Zyprexia would be
useful for treating the anger (and I could see how it would be), I don't
see why upping the dose (perhaps to 7.5 mg) and seeing what happens would be a
problem. Seroquel, another atypical antipsychotic might be useful in this
regard, as well. It (probably) carries with it a lower risk of TD, also, it would
seem. I'd give the Zyprexia a shot, first, though--I suspect that it might
be better for your purposes than Seroquel.

However, the nature of your son's condition puts this way out of my league.
I responded because I wanted to do anything I could to help, but hopefully
Toby or someone will respond also.

Best of luck to you, and please keep us posted on how you are doing.

Best wishes,

Matt

 

Re: Meds For Bipolar, CD and ADHD Son

Posted by Karen on April 5, 1999, at 13:38:58

In reply to Re: Meds For Bipolar, CD and ADHD Son, posted by Matt on April 5, 1999, at 3:11:41

> Karen,
>
> I'm really sorry to hear about all you've been through--I can't imagine what it all must be like, both for your family and for your son.
>
> I don't know tons about ADHD, but I know a bit. So take this with a grain
> of salt. Cylert is one possibility, certainly Another is an
> activating antidepressant like Wellbutrin or a less sedating TCA
> (nortriptyline or perhaps protriptyline). Wellbutrin (which is sometimes
> used for ADHD) would seem a better choice, because of your son's prior
> experience with Imimpramine. Wellbutrin also would be a good choice for
> the depression side of the bipolar.
>
> Zyprexia 2.5mg is used in more than a few patients for relief of anxiety,
> unclear thinking, etc.. 10mg is a normal dose for antipsychotic use, though anywhere from
> 5-20mg is used for this purpose. If the doc thinks that Zyprexia would be
> useful for treating the anger (and I could see how it would be), I don't
> see why upping the dose (perhaps to 7.5 mg) and seeing what happens would be a
> problem. Seroquel, another atypical antipsychotic might be useful in this
> regard, as well. It (probably) carries with it a lower risk of TD, also, it would
> seem. I'd give the Zyprexia a shot, first, though--I suspect that it might
> be better for your purposes than Seroquel.
>
> However, the nature of your son's condition puts this way out of my league.
> I responded because I wanted to do anything I could to help, but hopefully
> Toby or someone will respond also.
>
> Best of luck to you, and please keep us posted on how you are doing.
>
> Best wishes,
>
> Matt

Thank you so much for responding Matt. I appreciate the input. Karen

 

Re: Meds For Bipolar, CD and ADHD Son

Posted by Karen on April 5, 1999, at 13:50:40

In reply to Re: Meds For Bipolar, CD and ADHD Son, posted by Karen on April 5, 1999, at 13:38:58


> Thank you so much for responding Matt. I appreciate the input.......DR. BOB and/or TOBY:
ANYTHING TO ADD TO MATT'S COMMENTS? Karen

 

Re: Meds For Bipolar, CD and ADHD Son

Posted by Hank Lerner on April 7, 1999, at 19:45:58

In reply to Re: Meds For Bipolar, CD and ADHD Son, posted by Karen on April 5, 1999, at 13:50:40

>
>Hi, You and your child have been through a lot!
Hope that things settle down and improve. This may
Help! I'm a professional counselor and work closily
with a psychiatrist. We treat kids and adolescents
with ADHD, CD, and Bipolar.

There are a few options which might help. I assume
your son's angry and impulse control problems are
the primary issue (as opposed to attention)at this
point. We have had good results with the use of
neurontin ( anti-epilespsy drug used as mood stabilizer)
It seems to reduce anger, impulsivity and anxiety.
Kids tell me they feel calmer and more in control.

While Zyprexia may be an option it has side effects
(sedation, and TD) which are something to consider.

Wellbutin is an option (if not history of seizure)
It has effects on attention and impulse control. We've
used it with Neurontin, as we have Stimulants and
Neurontin.

While Neurontin is an off label use, I'd discuss it
with your child's psychiatrist.
If I can help further, let me know.
Hank

 

Re: Meds For Bipolar, CD and ADHD Son

Posted by Karen on April 11, 1999, at 0:52:03

In reply to Re: Meds For Bipolar, CD and ADHD Son, posted by Hank Lerner on April 7, 1999, at 19:45:58

Thanks Hank for your information and kind reply to my request for help. Yes, our main concerns at this time are anger and impulsivity. My son is currently taking: Neurontin, 300mg three times a day and Zyprexa at 5mg once in the evening. Apparently the plan is to stabilize our son on these two meds and then add the Wellbutrin for the exact same reasons you spoke of...using it instead of a regular stimulant. DO YOU HAVE ANY EXPERIENCE WITH WELLBUTRIN SR as opposed to regular Wellbutrin regular? I am wondering if the
SR is really helpful or if it is like so many of the SR or extended life stimulants....not all they're cracked up to be! Thanks again for the assistance. Your advice is appreciated. :)


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