Akasthia vs mania

[smallworld]

You mean before he was rxed Prozac?

Many kids, including my two older ones, are rxed SSRIs as first-line treatment for anxiety and depression. It is only after they "flip out" that it is discovered they have a mood disorder that needs to be treated with MSs.

 

[klmno]

I meant after the prozac- should he have gone on MS's? If it was prozac induced mania, that doesn't necessarily mean he has BiPolar (BP), correct? (I know he has and did have some sort of mood disorder- I just am not 100% positive that it's bipolar or that there is a chemical imbalance that caused it. I might be 80-85% sure.)

Anyway, if it was prozac induced mania or even akastheia and he's not truly BiPolar (BP), , wouldn't putting him on MS's be a horrible mistake?

 

[BusynMember]

Hi again. Remember, we're not the doctor...lol. You can have Prozac induced mania and not have bipolar (my son did). I have a mood disorder, and there is no end to the new, funky names they are calling any mood disorder that isn't obvious bipolar. The new one that they hung me with is "Mood Disorder Spectrum." Hmmmm...I like it! Anyway, we really can't tell you what your child will do well on. Mood stabilizers are necessary for some people with mood disorders and, no, I don't think it's a bad idea to try them, even if it's not full blown bipolar. For me, I was an adult when they put me on Lithium and I just hated how I felt on it so I did without it. And strange medications--Paxil and Clonazapan--work as mood stabilizing for me so I don't really need one to stay on an even keel. It's so very individual and can take so maddeningly long to find the right combination. All I can say is hang in there. If you don't like your psychiatrist, find another one. If he or she isn't helping your child, I'd move on.

 

[Jena]

It is confusing, but think back this is what i do, before the medications' if possible. What were his behaviors like? Did he suffer from bouts of depression and than switch into suddenly being ok but more than "ok", hyper, pressured speech, like he's ontop of the world?? Also I Have learned that BiPolar (BP) and anxiety go hand in hand. Which to me makes logical sense.

People look at bipolar as this horrible thing, obviously it's not good. Yet when you break it down it is a brain in which has a chemical inbalance and shifts from the depression into the high geared manic stuff. They just bounce back and forth and their never just "even". I've read that bipolar can also be brought on by traumatic events in life also. It can lay dormant for years than suddenly boom your all over the map.

Listen to your gut on this one. Do you see his behaviors as being worse now? I have been told by many doctors that prescribing a MS to a child who is not bipolar will not do great harm as long as the amt is low, cause that's always my big question, what if your wrong and prescribing a medication that shouldnt' be being used.

Now, here's a thought. Again just talking from experience. What if he was weened off some of the medications at this point?

 

[Jena]

Also i've been told by 3 doctors it takes years of monitoring a child, anyone under the age of 18 to give a firm diagnosis of bipolar. I know some doctors out there are diagnosis'ing it. Yet I think now their being more careful. So, it may take years to know exactly what he does or doesn't have. Yet as i've learned here regardless of the diagnosis treating the symptoms is key. It doesn't sound like the mix he's on is helping him at this point, I know how frustrated you must be.

 

[klmno]

Thank you all so much. I'm so full of doubt right now- worry that I haven't found a better answer for my son, that I so desparately wanted.

Before medications, he started with a serious depression and internalization of negative thoughts/ideas about himself. Some things had transpired that he blamed himself for, although they were never his fault. He was not a difficult child before then. He was 10 1/2yo. He would not listen to me when I tried over and over to relieve his pain and self-blame and negative thoughts. He started stealing and then became erratic and he started doing such erratic and unpredictable things that I thought he was going to kill himself, although he wasn't directly trrying to commit suicide. Then, it kept getting worse and I was afraid that someone else could get hurt in the process, even though he wasn't deliberately trying to hurt anyone.

During that course of time, I had him with tdocs, psychiatrist who didn't put him on medications right away but continued to see us and lined us up with neuropsychologist testing, difficult child was in the phsop because I couldn't wait anymore- I swear I thought he was going to die. The tdocs were making things worse so I stopped them and started spending some time with difficult child just listening- really listening to anything he would tell me. He was on prozzac at this time but I saw no difference in him until about 2 mos later.

Then, suddenly- very suddenly- he was a different person again. Honestly, we don't know why. Was it because I was listening and trying to improve things that bothered him? Was it because he matured? Was it the prozac, even though there was no gradual change after 6 weeks- it was more like a miraculous cure? Was it bipolaar and the cycle ended?

Then, it all started again. A year later, he started being disruptive at school, the prozac was doubled, he got in trouble at school then went out and started a brush fire. Prozac was abruptly stopped, and this is where we are now.

Really, I just think it is tremendously sad that our mental health professionals are not further along than they are. All of them. There are tdocs who can't handle anything more than a typical arguement out here claiming that they can help any problem there is. We have the psychiatrists and medication companies handing out stuff when they still are saying that they have no idea what will help- but be cautious it could cause long term harm.

And we parents are sitting here desparate for help for our kids, then getting so frustrated with our kids because things haven't changed any and we have no more resources. So, we have to look at sending them somewhere that makes them live by a "do or die" order or else, they'll be locked up.

I am so torn and confused right now.

 

[smallworld]

How soon after the Prozac was discontinued was a MS started? How was his behavior when the Prozac was removed?

 

[Steely]

KLMNO.................Gosh, I read your post and you remind me exactly of me. Exactly. I was just perserverating over how Matthew has had a headache for 2 days and it must be one of the new medications he was given.

However, I just wanted to add I have seen both in Matt. They present themselves actually completely different if you were there and watching the person, and know them well. Mania is the racing thoughts, fast speech, impulsive actions like you described what happened when your difficult child was on Prozac (which is when he first got in trouble, right?) Wild thoughts, thinking that is not based in reality, anger, etc.

Akasthsia is more like MWM described it. Matt was pacing, could not stand the clothes on his body, could not sit down, could not stay still, high anxiety, and was visibly miserable. He could barely tolerate it the physical component - where with mania he is not as aware that his thinking is wrong or skued - and he is physically not uncomfortable.

 

[BusynMember]

KLMO, I can tell you right now that if the SSRI was abruptly stopped without any weaning, he is going to have a bad reaction to that. There are times when doctors just yanked me off certain antidepressants. Whether they were tricyclic antidepressants (imiprimine, amitriptylene) or SSRIs (Prozac, Zoloft) I had a jarring, horrible reaction to being yanked off of them abruptly. It seemed my body chemistry was out of whack and (I will try to again explain the best I can) it was NOT akathesia, but it was "not being right." I felt all screwed up and EXTREMELY depressed and irrational. I am not a violent person, but when I was yanked off an antidepressant once, I took the car and smashed it into the cement garage wall, damaging the entire front end. I was so screwed up, I don't know if I was just crying for help or suicidal. Medication is serious stuff. I know. I've been on a ton of medications in my lifetime and I've gone through almost everything you can on medication because I'm very sensitive to side effects AND I know the horror of changing medications and being removed from medications. It's NOT smooth sailing. It is NEVER smooth sailing, especially with antidepressants. Until recently, doctors didn't even tell anyone (and I don't think they do it enough today either) that these medications cause dependency and that it is about as hard to get off of SSRIs as benzos. But being taken off of any drug is going to screw when your brain and body chemistry. Changing a medication will also mess with your body and brain chemistry, although I was always better when a doctor didn't just pull me off an antidepressant, but replaced it with another one. Cold turkey was hell. And weaning was also hell at times. Many medications made me feel much worse rather than better. Some made me feel maybe 50% better, but it wasn't enough to stop suicidal thinking and erratic behavior. And sometimes the medications that were originally effecitve completely stopped working for no reason at all. Prozac, for example, made me hypomanic and feeling good for about six weeks then abruptly "pooped out" as we shrink patients call it. I was as depressed as ever and started having horrible nightmares on top of it. They doubled my Prozac dose to try to get the good effects back (I like hypomania), but doubling it made me feel even more depressed, not better. That's the paradox of medications. Sometimes too much makes it even worse. I notice doctors try to counteract medication "poopout" often by increasing the dosage, but that doesn't always work. Often it makes you feel doped up and even more depressed or too souped up. It's a very fine line between too little/too much/wrong medication/side effects and toxicity. I'm 55 and have been on: Amitripylene, Imiprimine, Nortriptyline, Lithium, Prozac, Zoloft, Inderol (this medication made me totally depressed), Tegretal (ditto), Valium, Senoquen, phenobarbital, thorazine (ick, ick, ick, ICK) and finally on the medication combo that works--the ONLY one that works for me--Paxil and Clonazapan. So I've taken my share of drugs and know what they can do to a person. I was also in a psychiatric hospital three times, once for ten weeks, and had a chance to talk to others on medication. I spent years in a group of people with mood disorders and ditto. It is very delicate and complicated to take medication and I got lucky to have EVER found something that is so effective. And Paxil and Clonazapan are not recommended for moodswings, but they are magical for me. This is very unscientific and I felt like a guina pig half the time. I would never change my medications again. If I ever slipped I'd do ECT first (truly). As for side effects I've hallucinated from medications (all three tricyclics), I've had akethesa (Zoloft), depression (Prozac, Inderol, Lithium, Tegretal, phenobarbital, Senoquen), mania (Prozac, Imiprimine), cognitive dulling (Lithium big time, Tegretal, Inderol) and anxiety (Prozac, Zoloft). As you can see, often the things that are supposed to stop anxiety caused more anxiety. And, of course, antidepressants aren't supposed to cause depression and hallucinations, but I had no tolerance to tricyclics. On amitriptylene, I hallucinated for a week and they put me in the hospital. I don't remember anything until the third day when I started coming down. They told me the reaction I had was like an LSD trip, making me wonder why anyone would want to take LSD! At any rate, trust your mom gut. If something seems "off" about the medications and the doctors say "it can't be", well, it most likely CAN be anyway. I was told "B-b-but that's only 1/2% of people who get that reaction..." It's 100% if it's you. Take care

 

[klmno]

How soon after the Prozac was discontinued was a MS started? How was his behavior when the Prozac was removed?

1) About 6-8 weeks, I think- and he was not on any medications during that time

2) At first, like nothing had changed although it thought it odd that he'd just gotten in all that trouble legally and at school and it didn't seem to phase him, then there were times he would rage, he couldn't sleep at night, his interest in sex and the computer sites about sex sky-rocketed (he was 12/crossing the biggest line of puberty), he was angry, then it went to biting his nails compusively, not being able to sit still, seemingly high-anxiety, and this is when he told me (then psychiatrist) that there were periods of time (phases) that he could not feel pain normally and his body didn't feel normal

Steely- my doubt is that what is being described as askasthia is what I would have said is hypomania- and have told psychiatrist "difficult child is hypomanic"- except- difficult child goes on cleaning sprees during those periods of time, too, but I thought that was to keep himself moving around. Anyway, difficult child has had medication changes as a result of this- depakote was originally added to the lithobid because of difficult child feeling and behaving like that; actually, that's the way difficult child was acting at the time the MS's first were given, although he had gone thru a few phases of different "moods" prior to that, as described above, and when the MS was first added, difficult child was doing a short stint in juvy and I had gotten permission to check him out to take him to psychiatrist

 

[klmno]

If something seems "off" about the medications and the doctors say "it can't be", well, it most likely CAN be anyway. I was told "B-b-but that's only 1/2% of people who get that reaction..." It's 100% if it's you.

LOL!! Yes, I have had that conversation with difficult child's pediatrician and psychiatrist several times over various medications!! (Albuterol, Dimettap, steroids, an antibiotic, lamictol, depakote, lithium, zyrtec, risperdal, and then difficult child had the conversation with psychiatrist himself about the anti-anxiety medication)

difficult child had his 1 1/2 hr crime spree where he started a brush fire, among other things, and got 7 legal charges for 1 1/2 hr of action about 13 days after having his prozac doubled, he had been put on a long term suspension from school (I know- I did fight it) and I had been called to come and get him because "he was out of control and they could not handle him" at school 10 days after that prozac change. The prozac changed due to signs of depression and minor disruptions at school.

Anyway, after I called and told psychiatrist all this, he told me to stop the prozac immediately that he thought it made difficult child manic. I asked if it wasn't dangerous to stop the prozac immediately. psychiatrist said if difficult child had already done all that after that increase, which psychiatrist said was still a low dose (it went from 10 to 20mg/day), that it wasn't as dangerous to stop immendiately as it would be to leave difficult child on it. But he also told me to watch difficult child like a hawk for about a week and not let him out of direct supervision.

 

[susiestar]

I found this link from a law firm which directly addresses prozac and akasthia: http://www.productsthathurt.com/companies/eli-lilly-and-company/prozac.php

I don't know if it has any new info for you, but thought it couldn't hurt.

I hope you can figure out what is going on and help difficult child learn to cope with it.

 

[totoro]

Prozac made me feel horrible... I felt like my brain was caving in. Among other things. I felt crazy...
I have seen the difference in K. It is what everyone has described.
She now has the more Hypo symptoms or Manic symptoms. Not the Akathesia. She did have that with Risperdal and Abilify at certain doses.
She is more like the textbook description of Hypomania... her mania is a lot less now on Seroquel.
It is confusing...
For us the pressured speech and restlessness is a sign. Her agitation is different she is more irritable also. I guess ODD is worse. EVERYTHING is worse!

 

[smallworld]

Hi klmno, I attended a talk this afternoon by Dr. Kenneth Towbin, a researcher at NIMH who is studying pediatric BiPolar (BP) with Dr. Ellen Leibenluft and others. A woman in our group asked what it meant in terms of diagnosis when a child has a manic reaction to an SSRI. Dr. Towbin said there is a difference between activation and mania. Usually activation occurs when the psychiatrist prescribes the medication to start at too high a dose or makes increases too quickly. Jumping from 10 mg to 20 mg without interim dose increases could have caused activation. Activation generally stops when the SSRI is out of the blood stream. Prozac has a long half life, which means it can stick around in the blood stream for a while (and because of its long half life, it is less problematic to stop it abruptly -- unlike Paxil or Effexor -- although M's psychiatrist did wean her from Prozac 5 mg at a time). Dr. Towbin made the point that having a bad reaction to an SSRI is not in and of itself indicative of BiPolar (BP). You have to have a manic episode separate from medications for it to be considered BiPolar (BP) (and it has to be the hallmark sx of mania as listed in the article I cited above).

Dr. Towbin and his colleagues are conducting a variety of studies at NIMH for which your difficult child might qualify. It's at no cost to you, and after your difficult child is finished, the researchers are happy to consult with your outside psychiatrist. If you're interested, PM me and I'll send you the contact info.

by the way, how did your difficult child respond to Lithium on its own?

 

[klmno]

Thanks, SW!! I Pm'd you. difficult child's regular psychiatrist says this is indicative of bipolar, however, he has to account for putting difficult child on MS's to the insurance co and the courts (since difficult child is in legal trouble and has been declared CHINS (in need of services). But, Dr X (the infamous one who lead difficult child's MDE), says she does not think difficult child is BiPolar (BP)- actually, she wrote in his report that BiPolar (BP) is ruled out but that difficult child should remain on MS's until he has adequate psychotherapy and cognitive therapy to help him with coping skills and the tendency toward self-destructive behavior.

Now, I wonder if that is the same as the prozac "activating" cycling. Dr X knew difficult child's history with medications and so forth- she knows difficult child's regular psychiatrist and I was told that they had discussed difficult child's several times. Anyway, thanks for the info...