Input on medications

[crazymama30]

So difficult child currently takes 5mg abilify and 50mg vyvanxe in the morning, and 10mg abilify, 250mg Lamictal and 7.5mg melatonin as needed at night. We also give him 2mg abilify as needed when he gets out of control, but sometimes that is not cutting it.

I have seen more acting out lately, more obnoxious behavior, trying to get on everyone's nerves, and even some physical agression. He is suspended from school today and tommorrow due to him getting in a fight after school on the last day before christmas break.

I think we need to do something, but wonder how much of his behavior is his disorder or all the **** that we have been through lately with husband? husband has been in the hospital twice for OD'ing on his pain medications, and I kicked him out for a week to 10 days and he is currently clean from pain medications and in a lot of pain.

I have a call into difficult child's psychiatrist, and think she will want to add a stimulant in the evening. This may be a good idea, as I can certainly see a positive shift in him for several hours after he takes his morning stimulant, but worry about giving him too much and the impact of that possibility. It seems to me he is on a pretty high dose of abilify. Any ideas or thoughts? I would like to wait untill things calm down with husband, but difficult child tends to react to things after stuff calms down. So as things get calmer, he could get worse. I am at a loss of what to do next, and await hearing from psychiatrist.

 

[smallworld]

CM, sorry things are so rough for you right now.

The one thing to consider with your difficult child's medications is that all of them tend to be activating. In other words, both Lamictal and Abilify work on depression and stimulate rather than calm. My understanding about Abilify is that less is actually more (in other words, less actually helps more). And higher doses of stimulants with kids who have mood disorders can help or hinder -- it's a crapshoot. So I'm wondering if maybe your difficult child needs to trial a different AP other than Abilify. Has he ever been on a different one?

Hang in there -- hope the psychiatrist has some ideas for you.

 

[crazymama30]

nope, he has only been on abilify and every time we increased the dose we have seen a dramatic benefit. We will see what psychiatrist has to say. I just know that he has got to calm down. He is super out of control, especially in the evening. Like now!!!!

 

[gcvmom]

Whether you pin it on the disorder or the circumstances, it still speaks to his relative fragilty/tenuous stability.

Wish I had some solid advice on the medications. I wonder if it's a matter of the Lamictal not adequately addressing the depressive symptoms -- cuz in our house, anger, aggression and violence usually = depression. It's proven true for husband, difficult child 1 AND difficult child 2. And I suppose for me, too, lol!

 

[crazymama30]

G and S, you both have very good points. I think I will tell psychiatrist what has been going on, tell her how difficult child has been acting and how often we have had to give him the prn dose of abilify, and let her decide. I was leary of changing psychiatrists, but I have more faith in her knowledge than in previous psychiatrists. She keeps up more on new things, and just went to a conference. She just seems more knowledgable, and I have never gotten any negative feedback from anyone about her. Once we changed psychiatrists, I would never go back even if we could!

difficult child just had a major blow up. He had been teasing the dog all night, and wanted to go outside to play with his new remote control car (christmas gift). He took the car outside, and started playing with it on the porch. Now we have a cat door in the front door (thank you husband for your wisdom!!!!). The dog was so wound up that he went through the cat door with his head and bit the car. difficult child came unglued...threatening to kill the dog and has no idea how his previous actions from today and from many other days caused the dog to do this. I gave him the option of taking extra abilify or taking melatonin, he chose abilify. Now he is almost asleep.....thankfully.

 

[gcvmom]

Hope the rest of your evening is peaceful. And I hope the psychiatrist calls back tomorrow.

 

[crazymama30]

If she does'nt, then I have her home and cell numbers, but I don't want to use them unless I have to, and don't feel this is an emergency but rather a situation that cannot wait untill our next appointment in 2 1/2 months!

 

[gcvmom]

I agree -- definitely needs to be addressed NOW!

 

[confuzzled]

crazymama--i have a question that has really nothing to do with yours, but i'm curious.

how has your difficult child's weight been with the combo of abilify/vyvase? do you find his appetite is typical?

i'm curious because i was told that a low dose stimulant may be a consideration to stop the abilify weight gain...which after a disasterous concerta trial scares the bejesus out of me. my psychiatrist finally admitted that they are NOT seeing weight neutrality in kids and they are finding it to be a pound packer on-er. i couldnt get a straight answer as to why they think its the case (appetite increase? metabolism changes? not truly conquering the depression symptoms on its own?).

**************************

it is also my understanding that while of course a lower dose of anything is optimal, the kids that do best on the 1-2mg/day dose of abilify are the spectrum kids or the "add ons"--a higher dose is needed for most mood disorders.
15-17mg is what i would think of as a pretty appropriate dose (i've never heard of using it as a prn, but it sounds like it works for you, and thats all that matters). from what i know, 30mg is the generally accepted "top out" dose.

anyhoo--just curious about the abilify/stimulant combo....

 

[crazymama30]

Confuzzled, when difficult child was not on abilify he was VERY skinny. I had to buy him slim size jeans. Now keep in mind he is a small kid by genetics, he is not even 5 feet tall and only weighs currently about 90lbs. When we started abilify he did not gain weight untill we got to the 10 to 15mg dose, the 2 and 5mg doses did not do anything to his weight. He has put on weight, and is not what I consider overweight. I had to go buy him husky jeans (only a size 12 boys) as the 12 regulars were too tight. The huskys are way to big, and we have to cinch in the waist but he hates tight clothes. A 14 would be way too long.

Hope that helps.

 

[confuzzled]

it does, thanks. that was pretty much what happened here too with the abilify--lower doses were fine weight and appetite wise, but when we got to 10mg she really gained, and i really cant say it just appetite increases.

im not sure i'm up for adding a stimulant anyway so thanks for responding. but i was kinda hoping you'd tell me differently.

its never simple.

 

[BusynMember]

When it comes to medications often less is more. A lot of times (and it has happened to me) medications ARE the problem and adding more medications make it worse. Remember that medications will not solve any problem and that too many can work against the child. It is a matter of finding the right dosage and the right medications. in my opinion to keep adding medications is not always the right solution. In my case, it definitely helped me to DECREASE medications. I think stims are a bad idea. JMO

 

[JJJ]

With Kanga, we would see the dramatic impact of the APs when we upped the dose and then, as her body adjusted, all the symptoms would come back. She is now trying Thorazine instead of an atypical-AP -- the psychiatrist said what smallworld did about Abilify being 'activating' and he said that he has found the old school APs to work far better on some kids that tend to have these kind of problems. Of course, the old school APs have more side effects but it is always a trade-off in our world, isn't it.

 

[GoingNorth]

I've taken both Zyprexa and Seroquel and BOTH of them not only put on about 60lbs (in total), but I developed a really scary sideeffect to both medications: basically incoordination of the involuntary muscles used in swallowing and to a lesser degree breathing. Very scary and my psychiatrist had only heard of a few cases and he's been in practice for better than thirty years.

It was decided it was too risky to play around with other APs, and I was put on HALDOL...yep, good ol' fashioned medication alright.

Thorazine is closely related to Haldol and is weight neutral. In fact. Haldol at least can cause loss of appetite in a lot of people.

I've managed to finally lose a few lbs of all that weight I put on, and that's battleing the Depakote carb cravings as well.

ALL of the old-line APs carry Tardive Dyskinasia (Involuntary movements of muscle groups such as the tongue or face, even limbs) as a risk, but TD usually only shows up at very high doses given over long periods of time. I take a low dose of the medication and it works well enough that I am sort of POed about having "had" to try the atypicals first.

 

[crazymama30]

Here is the news ladies. psychiatrist thought about increasing the Lamictal, but then decided to increase the abilify. He is going to tak 5mg in the morning, 5mg when he gets home from school, and 10mg at night. husband is going to an intpt treatment facility today or we are getting divorced, so the next few days could be more peaceful or worse. I will know after today is done.