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Dr. Bob is Robert Hsiung, MD,
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Posted by Lou Pilder on February 18, 2012, at 22:01:59
In reply to Re: Desperate, posted by Christ_empowered on February 18, 2012, at 21:56:21
> All I can think of is cut or reduce the ADHD meds, especially the amphetamines. I mean, you can reintroduce them later, but if there are mood problems on the irritable+hypomanic end of things, I would think cutting out uppers would be a good place to start. On the downside, sedation from the other meds might become more of an issue.
C_e,
You wrote,[...cut or reduce...]
I was preparing a response here concering a little of what you have posted here. I am having some difficulty right now with technicals in posting.
Lou
Posted by Christ_empowered on February 18, 2012, at 22:06:36
In reply to Lou's response-***** » Christ_empowered, posted by Lou Pilder on February 18, 2012, at 22:01:59
Hey Lou. Have you taken meds before? I used to hate psychiatry and meds and everything. Honestly, I'm still not all that pleased with psychiatry. However, I benefit from my Abilify. I'm asking you about your history because I think you may benefit from some of the very meds you seem to despise so much. I had problems thinking and articulating my thoughts before the Abilify. Now I can think, write, and express myself clearly--and I stay out of mental hospitals!
Think about it, please.
Posted by Solstice on February 18, 2012, at 22:08:28
In reply to Lou's response-***** » Christ_empowered, posted by Lou Pilder on February 18, 2012, at 22:01:59
Posted by herpills on February 18, 2012, at 22:15:43
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
I'm sorry to hear your daughter is not doing well. My opinion is it seems like the meds need to get straightened out first. From what I understand you are saying she dropped the Geodon and then is put on Lamictal, Lithium, and Latuda? I just feel like she is on too many meds, but I know it's hard if she has ADHD and bipolar. Keep working with her doctor and also take advantage of any non- med options that could help. Is she involved in any activities that help her focus/calm?
Posted by Solstice on February 18, 2012, at 22:16:03
In reply to Re: Desperate, posted by Christ_empowered on February 18, 2012, at 21:56:21
> All I can think of is cut or reduce the ADHD meds, especially the amphetamines. I mean, you can reintroduce them later, but if there are mood problems on the irritable+hypomanic end of things, I would think cutting out uppers would be a good place to start. On the downside, sedation from the other meds might become more of an issue.
Yeah.. I've been wondering if the Vyvanse is something we should take out of the mix - but historically, whenever she has inadvertently missed her Vyvanse, we've paid dearly.. in that she has a really bad day where she's just totally unable to manage herself. But still, it might be worth discussing with her PDoc... Thanks CE
Posted by Solstice on February 18, 2012, at 22:41:53
In reply to Re: Desperate » Solstice, posted by herpills on February 18, 2012, at 22:15:43
> I'm sorry to hear your daughter is not doing well. My opinion is it seems like the meds need to get straightened out first. From what I understand you are saying she dropped the Geodon and then is put on Lamictal, Lithium, and Latuda? I just feel like she is on too many meds, but I know it's hard if she has ADHD and bipolar. Keep working with her doctor and also take advantage of any non- med options that could help. Is she involved in any activities that help her focus/calm?
Yes.. you got it right. She used to just be on Geodon and Vyvanse. First we titrated off the Geodon while titrating up on the Latuda. Then Lamictal was added, but it takes a long, long time to find lamictal's sweet spot. The lithium was added to hopefully reduce the acuteness of this extended episode. PDoc said that once my daughter's stabilized, she might get rid of the lamictal. I said "Why get rid of the lamictal? Lamictal has worked Great with her sister - it's so dang mood-stabilizing! If we're going to get rid of something, let's get rid of the lithium" PDoc agreed that I had a good point about the lamictal. And my daughter has complained that the lithium makes her hands shake. She really hates it. So that's the one I'd like to get rid of. I'm worried about what we're going to do, though, if the Latuda ends up being ineffective, and after being on it now for some 5 weeks, it just doesn't seem to be hitting the spot. Thanks for your input, herpills.
Solstice
Posted by Lou Pilder on February 18, 2012, at 22:47:05
In reply to I BEG of you Lou, please leave my thread alone (nm), posted by Solstice on February 18, 2012, at 22:08:28
Solstice,
You wrote,[...leave {(MY) thread alone...]].
That could mean a lot of things,and I do not know what your are wanting to mean by what you wrote. If you are wanting to mean for me to not post in this thread at all, then be advised that others have the freeedom to post in this thread, so I can also, for I am not telling you or anyone else to not post in this thread, since you did write asking for (all) others advise.
But it is much more than that. You see, I am here to give support and education. There are many people outside of posters in this thread that could be reading this. And you see, there is your daughter also involved here. So my responses could also not be only to you, but to many others that may also have a 17 year-old daughter in the same situation. I want to help not only you and your daughter, but those people also. It would also be of help if you did explain here what you mean by [...leave (MY) thread *alone*...], if you could.
Lou
Posted by Solstice on February 18, 2012, at 23:12:24
In reply to Lou's reply-chivkharmhoniegh » Solstice, posted by Lou Pilder on February 18, 2012, at 22:47:05
> Solstice,
> You wrote,[...leave {(MY) thread alone...]].
> That could mean a lot of things,and I do not know what your are wanting to mean by what you wrote. If you are wanting to mean for me to not post in this thread at all, then be advised that others have the freeedom to post in this thread, so I can also, for I am not telling you or anyone else to not post in this thread, since you did write asking for (all) others advise.
> But it is much more than that. You see, I am here to give support and education. There are many people outside of posters in this thread that could be reading this. And you see, there is your daughter also involved here. So my responses could also not be only to you, but to many others that may also have a 17 year-old daughter in the same situation. I want to help not only you and your daughter, but those people also. It would also be of help if you did explain here what you mean by [...leave (MY) thread *alone*...], if you could.
> Lou
I obviously can't stop you from posting. But, you are hijacking a thread I created that is important to me - with your own agenda. I want to hear from people on this board who have and/or understand bipolar illness, and have experienced or have knowledge of various effective treatments with medications and supplements.I don't want to discuss this with you. I don't want you to respond to me. I don't want you involved in my thread. That you have already buried it in your agenda, I feel like my story - my need for help - has been lost in a swirl of "Lou's reply" posts that are all about your agenda and have nothing to do with the questions I asked. I feel like I need to start a new thread all over again, because I fear so many people just skim over anything with your name on it, that my attempt to get the assistance I want will fall apart because you've taken it over.
Again, I realize I can't stop you from posting, but I would be grateful and consider it a generous kindness if you would refrain from involving yourself in the thread I created here to discuss my concerns about my daughter. Your ideas about medication are not something I am interested in. And by the way, it has nothing to do with whether I like you, and my desire for you to not be an obstacle in this thread is not a statement about whether you are a good person, etc. I just need to hear from people, and you are obstructing that by hijacking my thread, which is not considered good forum etiquette.
Please don't respond.
Solstice
Posted by papillon2 on February 18, 2012, at 23:13:52
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Her Lithium dose (90mg) is tiny, much less than the amounts even prescribed to augment anti-depressants in unipolar depression. You'll know when the blood level comes back, but I'm guessing it is minute and could be increased substantially. Lithium is the gold standard for bipolar and is very good for mania.
Are the shaky hands definitely coming from Lithium and not something else? I'm not doubting that it COULD be Lithium as I myself an extremely sensitive to Lithium and have toxicity symptoms at low doses (125-250mg). It just sounds like a lot of meds were added at the same time, which would be confusing for anyone in deducing which side effects come from each med. And as I said, that Lithium dose is TINY.
I think the side effects of Lithium are greatly overplayed. It is prescribed in much lower doses than it used to be and kidney and thyroid functioning are carefully monitored. I'd take it over an atypical anti-psychotic any day; the side effects of AAPs are far worse in my opinion.
Lamictal and Topamax are the only bipolar meds I can think of that don't cause weight gain in most people. However, while Topamax generally makes people lose weight it can produce significant cognitive impairment ("Californian Barbie Syndrome"). I agree that a blood relative performing well on Lamictal is reason enough to stick with it.
You may find this article helpful if you are concerned about cardiometabolic side effects. Refer to table 1 in particular: https://www.cmellc.com/CMEActivities/tabid/54/ctl/ActivityController/mid/545/activityid/2205/Default.aspx
Posted by sigismund on February 18, 2012, at 23:20:10
In reply to Re: Desperate, posted by papillon2 on February 18, 2012, at 23:13:52
I would be taking things away rather than adding more.
Posted by Solstice on February 18, 2012, at 23:27:20
In reply to Re: Desperate, posted by papillon2 on February 18, 2012, at 23:13:52
> Her Lithium dose (90mg) is tiny, much less than the amounts even prescribed to augment anti-depressants in unipolar depression.
I'll have to look at it again - she's actually on 900 mg (not 90). The shaky hands thing didn't show up until she started the 600 mg - and once she got to 900, that's when it got noticeably problematic for her.
> Lithium is the gold standard for bipolar and is very good for mania.That's what I've always heard.. I don't know why lithium seems scary to me.
> It just sounds like a lot of meds were added at the same time, which would be confusing for anyone in deducing which side effects come from each med.
Yeah.. it is a lot. They were done successively, but in pretty close proximity, so it really would be hard to be sure. My daughter's the one who believes it's the lithium.. and I kind of have to trust her instincts about it since she's the one experiencing the effects of the medications as they've been added and increased.
> I think the side effects of Lithium are greatly overplayed. It is prescribed in much lower doses than it used to be and kidney and thyroid functioning are carefully monitored.Well.. I have to say that it's good to hear from someone who feels that way! I have kind of wondered about the thyroid thing. There are big thyroid issues on both sides of her family. Her thyroid hasn't been checked yet, but I'm wondering if we shouldn't do that, because it's certainly possible that her symptoms might be an indication that she has a poorly functioning thyroid. My own mother has been on thyroid medications since she was in her early 20's, so it's not out-of-the-question that my daughter could have an early-onset thyroid issue that's playing a role. If so, that would certainly explain why the Geodon 'failed,' and why the Latuda and lithium have seemed ineffective.
I really appreciate your input, papillon
Solstice
Posted by Solstice on February 18, 2012, at 23:32:52
In reply to Re: Desperate, posted by sigismund on February 18, 2012, at 23:20:10
> I would be taking things away rather than adding more.
Well, we took Geodon away and added Latuda, then the other two (Lamictal and lithium) were added to give the Latuda time to work. As for the lamictal, it has been so effective for her sister, that it just seems like a no-brainer that it might really help with the irritability/anger.
But I do get what you're saying. I wish she did not have an illness that is complicated by a comorbid condition, making it so especially difficult to treat.. and that often requires a mix of medications. :-(
Solstice
Posted by papillon2 on February 18, 2012, at 23:33:27
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Sorry, I just re-read your original post and saw that elsewhere you say she takes 900mg of Lithium, so I will take the 90mg you listed as being a typo.
Posted by Beckett on February 18, 2012, at 23:37:21
In reply to Re: Desperate, posted by Solstice on February 18, 2012, at 23:27:20
Fanapt is a new medication some are using to treat bipolar with mixed success. I know little about it. It is not approved for bipolar but like Latuda for schizophrenia. Maybe you know about it already.
I have been wondering how much your daughters rapidly shifting biology might have a role in her current destabilization. I will keep my fingers crossed for her.
Posted by Solstice on February 18, 2012, at 23:39:03
In reply to Re: Desperate, posted by papillon2 on February 18, 2012, at 23:33:27
I made a typo on my original post.
My daughter's current meds are:
Vyvanse - 80 mg
Intuniv - 3 mg
Latuda - 80 mg
Lithium - 900 mg
Lamictal - 200 mg
Posted by Solstice on February 18, 2012, at 23:46:21
In reply to Re: Desperate, posted by Beckett on February 18, 2012, at 23:37:21
> Fanapt is a new medication some are using to treat bipolar with mixed success. I know little about it. It is not approved for bipolar but like Latuda for schizophrenia. Maybe you know about it already.
Thank you Beckett! I will look into Fanapt. Haven't heard of it - and haven't seen it show up in the research I've been doing during the last week or so.
> I have been wondering how much your daughters rapidly shifting biology might have a role in her current destabilization. I will keep my fingers crossed for her.
Do you mean because she's a teenager? Believe me, that has been a stressful dilemma for me the entire time. I always question:
- How much is due to the state of adolescence?
- How much is due to ADHD?
- How much is due to bipolar?It is so frustrating to have so many overlapping symptoms (i.e. impulsivity is common to all three!)
I just want my baby to be okay. She was doing so wonderfully for so long... so this is just really hard for me. It's not a boo-boo I can kiss and make go away. :-(
Solstice
Posted by Beckett on February 19, 2012, at 0:04:23
In reply to Re: Desperate » Beckett, posted by Solstice on February 18, 2012, at 23:46:21
I was thinking of a major hormonal shift perhaps. I don't understand it at all, but some women eventually find contraceptives play a role in their mood health. I am not suggesting at all to introduce that to the mix now.
I think you continue to navigate this incredibly well, Solstice.
Posted by SLS on February 19, 2012, at 0:14:37
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Interestingly, I was thinking of Latuda, too. It was the logical next step. However, like your doctor, I have concerns that there is inadequate symptom reduction after 4 weeks.
I would think about adding Depakote. It can squash a bipolar II hypomania even more quickly than a neuropleptic antipsychotic.
Klonopin also occurred to me.
I also have concerns that the stimulants are making the bipolar worse, but an expert would know better than me. Bipolar and ADHD occur so often in young people. They are very often hard to separate. I am wondering if the distractibility is really a bipolar thing and not a ADHD thing. Maybe there is no ADHD to treat. But then again, things were good for awhile on Geodon while also taking the stimulants.
Regarding neuroleptic antipsychotics, Fanapt (iloperidone) has one of the better side effect profiles with respect to EPS and weight gain.
- Scott
Posted by Solstice on February 19, 2012, at 0:27:18
In reply to Re: Desperate » Solstice, posted by Beckett on February 19, 2012, at 0:04:23
> I was thinking of a major hormonal shift perhaps.
You make a good point. All my 3 kids were slow to reach puberty. It's my youngest that we're talking about, and she did not reach menses until she was 14.5 yrs old and in high school. She loved being so small compared to her age mates. She was petite and just adorable. Her physical immaturity became part of her identity, especially because others commented on it all the time. When she started Abilify, she gained quite a bit of weight at the same time that she was finally developing her 'womanly' figure, which was downright traumatic for her. And let me tell you, she spent two years resenting her short stint on Abilify. It took her a long time to adjust to being a young woman and she just couldn't be convinced that she would have developed that womanly shape regardless of the Abilify :-). She's okay with it now, though.
> I don't understand it at all, but some women eventually find contraceptives play a role in their mood health. I am not suggesting at all to introduce that to the mix now.
Yeah.. I hadn't thought of that. I have never been terribly 'hormonal' - in that I don't have swings. I didn't have them during my pregnancies - I just never had ups or downs or unstable days (until I dropped down the hole of major depression in response to C-PTSD.) Anyway, so I don't typically even think about it, but I think you're right that she may be one of the many women who are yanked around by the nose by their cyclical hormonal shifts. Thanks for bringing it up - because I think it merits being on my list when we see the PDoc on Tuesday.
>
> I think you continue to navigate this incredibly well, Solstice.Thanks Beckett.. but I sure don't feel like I'm navigating it very well. She's been so very unstable, and of course, since I'm her safe place - all her irritability, anger, and distorted interpretations are directed at me.. so I frequently feel like I'm hanging by a thread. Since she's genuinely unable to 'see' the effect of her hypomania/mania, I think it's probably more traumatizing for me than it is for her. It sure does help me hang by that thread to be on the receiving end of kind comments like yours, though. :-)
Solstice
Posted by SLS on February 19, 2012, at 0:41:08
In reply to Re: Desperate » Solstice, posted by herpills on February 18, 2012, at 22:15:43
> I just feel like she is on too many meds,
How did you come to this conclusion? What criteria did you use?
You might be right, but I am interested to know why you feel that way in this particular case.
I don't know what the big deal is of having to take 6 different medications to treat one illness. What if someone needs to have 6 different processes manipulated simultaneously in order to bring balance to the system?
I think it is important to NOT discourage someone from treating a condition with multiple medications just because we don't like numbers. Of course, there are many instances in which drugs are prescribed that have no therapeutic activity in the individual. It becomes incumbent upon the doctor to identify these drugs at some point during treatment and remove them. However, I think that it is desirable to see symptom resolution before beginning to discontinue drug treatments.
Sometimes it is a matter of throwing a bunch of crap against the wall to see if any of it sticks. Someday soon, this crude way of treating mental illnesses will be unnecessary.
- Scott
Posted by Solstice on February 19, 2012, at 0:45:12
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 0:14:37
Hi Scott! Thank you for stopping in to add your thoughts.
> Interestingly, I was thinking of Latuda, too. It was the logical next step. However, like your doctor, I have concerns that there is inadequate symptom reduction after 4 weeks.
Yeah.. the PDoc said that Latuda is similar to Geodon, and since my daughter did so well on Geodon, Latuda was her first second choice. But then again, maybe the Latuda isn't effective for the same reasons that Geodon lost its effectiveness?
>
> I would think about adding Depakote. It can squash a bipolar II hypomania even more quickly than a neuropleptic antipsychotic.Really!? I'll ask her about it. I do know that she (PDoc) is somewhat careful about trying to stay with whatever is approved for 'children.' That said, my daughter is close enough to 18 that I think PDoc would consider medications that haven't been formally studied in children. And still again, I'll bet depakote has been studied in children, since it is an anti-epileptic.
>
> Klonopin also occurred to me.I'll ask about that one too.
> I also have concerns that the stimulants are making the bipolar worse, but an expert would know better than me. Bipolar and ADHD occur so often in young people. They are very often hard to separate. I am wondering if the distractibility is really a bipolar thing and not a ADHD thing. Maybe there is no ADHD to treat. But then again, things were good for awhile on Geodon while also taking the stimulants.You know, once I got a fairly good feel for the differences between her ADHD and Bipolar symptoms, I really became convinced that her distractibility is just way more intense than what would be 'normal' for ADHD. Professionals who have dealt with it (even at school), have always commented that they have never seen anything like it. So I don't know if it's just really potent because it's bipolar, or if she has a double dose or something. I just don't know how it works.. and it really is difficult to distinguish between symptoms. I've also wondered if she's really just got bipolar, and that maybe it hasn't been treated effectively enough to address the distractibility part.. but then again - For nearly three years Geodon and Vyvanse were a total package - and believe me - missing the Vyvanse was asking for a disaster. Since Geodon builds up, she could miss one, or take it later, and it didn't cause a problem. But man.. miss the Vyvanse and within a couple of hours the school was calling! Still.. stimulants can trigger hypomania/mania, so that cannot be dismissed, especially when her state of adolescence is taken into account.
>
> Regarding neuroleptic antipsychotics, Fanapt (iloperidone) has one of the better side effect profiles with respect to EPS and weight gain.yeah.. I looked it up and read some patient reviews (which were mixed, of course). however, one patient described themselves and it sounded exactly like my daughter - and they said the Fanapt really zapped the hypomania. And the weight gain thing is really important. So I can't wait to see the PDoc Tuesday to ask about it. But Scott - what is EPS?
Solstice
Posted by SLS on February 19, 2012, at 0:45:56
In reply to Re: Desperate » Christ_empowered, posted by Solstice on February 18, 2012, at 22:16:03
> but historically, whenever she has inadvertently missed her Vyvanse, we've paid dearly.. in that she has a really bad day where she's just totally unable to manage herself.
It sounds like the doctor got it right. Vyvanse is serving a very important purpose.
I have experienced manic reactions to certain medications, but amphetamine is not one of them.
- Scott
Posted by Solstice on February 19, 2012, at 0:49:03
In reply to Re: Desperate » herpills, posted by SLS on February 19, 2012, at 0:41:08
> Sometimes it is a matter of throwing a bunch of crap against the wall to see if any of it sticks.I love this. Especially because that's exactly what we're doing here, and all the 'bunch of crap' we're throwing is so scary for me as her mom. So it's helpful to me to think of it like you said it. Makes me giggle :-)
Solstice
Posted by SLS on February 19, 2012, at 1:01:43
In reply to Re: Desperate » SLS, posted by Solstice on February 19, 2012, at 0:45:12
> > Regarding neuroleptic antipsychotics, Fanapt (iloperidone) has one of the better side effect profiles with respect to EPS and weight gain.
> yeah.. I looked it up and read some patient reviews (which were mixed, of course). however, one patient described themselves and it sounded exactly like my daughter - and they said the Fanapt really zapped the hypomania. And the weight gain thing is really important. So I can't wait to see the PDoc Tuesday to ask about it. But Scott - what is EPS?Extrapyramidal symptoms.
EPS is the most important acronym to know when you are dealing with neuroleptic (DA antagonist) antipsychotics. Symptoms include involuntary muscle movements (dystonia, dyskinesia, torticollis, pseudoparkinsonism, chorea, etc). Akathisia is also considered to be a form EPS. Akathisia is a set of highly specific anxiety-like phenomena. There are instances where EPS can appear later in treatment (tardive) and become irreversible, despite drug discontinuation. These things are much more likely to occur with the older APs than the newer AAPs. I'm sure your doctor can provide you with more information about EPS.
- Scott
Posted by Solstice on February 19, 2012, at 1:01:45
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 0:45:56
> > but historically, whenever she has inadvertently missed her Vyvanse, we've paid dearly.. in that she has a really bad day where she's just totally unable to manage herself.
>
> It sounds like the doctor got it right. Vyvanse is serving a very important purpose.
>
> I have experienced manic reactions to certain medications, but amphetamine is not one of them.
>
Scott.. I know depression has taken up the most acreage in your battlefield.Please help me understand some things. It was clear initially that my daughter was hypomanic. When she started treatment, she was in absolute grief about losing that glorious feeling of hypomania. It took about six months for her to adjust to her 'normal' and to appreciate the feeling of being balanced.
What I'm wondering, is what does it look like when hypomania gets more manic? Her irritability and anger and reactivity is especially difficult for me to figure out. Before treatment, her hypomania was unremitting, but because it was pleasant, she wasn't 'easy' because of the intensity, but it wasn't horrible. The irritability and anger has been post-treatment, and it has seemed that the intensity of it is how her PDoc has identified it as a bipolar feature as opposed to teen 'attitude.' Over the last 3 years, it has been the appearance of excessive irritability and anger that has prompted raising her Geodon - and it always took care of it until the last time we did it, which was right before Christmas.
But, is the irritability/anger part of hypomania, mania, or is it actually a factor of depression? I have not known of my daughter having depression - but I'm wondering if her bipolar is evolving or something.
And.. thanks for letting me know that amphetamine apparently hasn't provoked mania for you. It helps to know it's not necessarily a 'given,' considering the problems we're having with quieting the symptoms she got right now.
Solstice
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