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Kiddo update

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by Tigger » Sat Sep 02, 2017 12:25 pm

I mentioned in a post in July that our 12 year old son had a really good first half of the summer. He seemed to be much more stable and was able to enjoy sleep away camp for 2 weeks (shocking to us!) as well as two day camps for two weeks after that. After that he was able to do 7 hours a week of tutoring from the school to make up for all the school he missed last year. So awesome.

But, over the past 2 or 3 weeks he's becoming more unstable. More depression, more irritability (never raging or tantrums just short tempered) more cycling. We saw his psychiatrist today for a check up. He's gained another 5lbs (that makes 25lbs since going on Abilify and upping the Risperdal). He is still a normal weight because he was very, very thin before he started medication in February 2016.

His doctor said that his profile is somewhat unusual for her practice: he has more depression and doesn't displaying the aggression or raging that she typically sees with children with bipolar disorder. When he is in a hypomanic cycle, it presents as either being super happy or a mixed state. But there is no anger or aggression that needs to be controlled. Because of this she's suggested that we add lithium to try to control the depression and rapid cycling, and eventually start easing back on the Abilify as soon as we know that he is stable. According to her, the Abilify and Risperdal work really well on aggression, anger and raging types of mania but not so much the depression. Lithium works better on depression and smoothing out cycles. The Risperdal we'll keep, however, because it works so well to control the mixed states. His biggest challenge, though, is depression because it keeps him from showing up for his life. She's going to start the lithium dosage very low (below a therapeutic level) and gradually build it up.

It was also really fortunate because he went through cycle *right* in front of her eyes. He walked in depressed. Couldn't look at her, couldn't tell her about his summer, very flat affect, etc. Within the 30 to 45 mins we were there it lifted and he presented as his normal, typical self. She got to see it which was great. She could see what a typical depression looks like as well as his normal baseline return. Not too many people actually understand what that looks like for him and it's just great that it was was seen by a doctor finally.

So, his drugs right now are 300mg lamictal, 17.5 mg Abilify, 1mg Rispersal and soon we'll add about 600mg lithium and titrate up.

She wants to keep the lamictal because the side effects are almost nil and it could be keeping him from bottoming out. Once the Abilify is gone and he's stable she'll start to pull back the lamictal.

Anyone have any thoughts on the meds management? I'm curious about your experiences. I know everyone is different but it helps to hear all experiences.
_______

Mom to 12 year old boy with bipolar
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by Stuckles » Sat Sep 02, 2017 12:49 pm

Hi Tigger,

My BP is also a lot more on the depressive side. I'm on both Lithium and Lamitor (Lamictal) and it has helped a lot. I also tend to be more irretable and short tempered than what I am rage prone, though when it does strike it's usually disproportionately volatile for the situation.

It's great that she got to see the symptoms first hand as she then has a objective view of it. I always feel like such a idiot when I switch cycles right in front of someone :oops: Feels so strange that I was breaking down the one moment and all happy the next, like I'm wasting their time.

Best of luck with him, sounds like they caught it early and he has a good support system. I wish they knew all of these things when I was a kid :roll:
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by Duckysmom » Sat Sep 02, 2017 2:22 pm

Sounds like your on top of it and so is his pdoc. Good that she saw the switch take place right in front of her. And he sounds like he's compliant. I hope that's the case.

Med changes are always a pain in my rump. I'm lucky I have a pdoc who makes changes slowly and tells me how to titrate up or down if needed when he is not available, like now while he's on vacation. He does have another pdoc filling in for him, but I hate trying to explain myself to a pdoc that doesn't know me unless it's an emergency.
"Do not pray for an easy life, pray for the strength to endure a difficult one."
Bruce Lee
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by Tigger » Sun Sep 03, 2017 6:30 am

Thanks guys. Stuckles your perspective is so interesting and heartbreaking--do you really feel as if you're wasting people's time? It makes me sad to think that maybe my son feels that way too. It hadn't occurred to me that there would be guilt layered onto what's already there :( I want to reach through the screen and give you a hug.

Ducky yes, thankfully, he's totally compliant. That doesn't mean he doesn't occasionally complain about the medicine. And when he was titrating up on the lamictal it was *really* hard on him. Horrible nausea. We almost took him off it then and switched him to lamictal (this was a different doctor) because it was so debilitating. He's been through the ringer in terms of side effects. :(

Hope both of you have lovely Sunday afternoons.
_______

Mom to 12 year old boy with bipolar
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by Stuckles » Sun Sep 03, 2017 8:33 am

Aww thanks Tigger but it's more than likely my own fault as I recently discovered. I still have boundary issues and this is part of that. I don't think at that age it had manifested itself yet, for me at least.

The thing with these kind of conditions is that there are so many diverse symptoms that vary from one person to the next that you can't possibly think of all of them. Deal with the issues you know of and handle the others as they come up. I'm staunch supporter of researching and being informed about ones condition but it can have it's pitfalls. Let his therapist guide you and give you informed advice.
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