HI
I went back and read your first post. Just a quick note about our experience with our youngest who is Fetal Alcohol Effects (FAE). He has been extremely hard to medicate, to say the least. psychiatrists have told us that Fetal Alcohol Effects (FAE) can often make it much more difficult to medicate kids. Oppositional nasty, but also very sweet when things are going his way. Always in other kid's space, and very social at the same time. Not all autistic or on the spectrum.
We started off on stimulants about 5 years ago since he had trouble focusing--they were a disaster, made him very anxious, tearful. Went through many other medications (probably about ten or fifteen), including two tries on Tenex, which built up over a course of a couple of weeks into very nasty violent aggressive behavior--so bad I sent my husband to a motel for the night after my son kicked in him the privates for the second or third time. You get the picture. Definitely a reaction to Tenex. I would really urge you to talk to your psychiatrist about the medication because I think it could definitely be responsible for the agitation and all that you are seeing.
Prozac did not work at all for son--made him disinhibited.
A psychiatrist finally prescribed low dose abilify which seeemed to help focus at school and make him less impulsive. Finally something that worked. But as he is going through adolesence now it seems to work less and we finally took him off. I was really reluctant to try other AP because he finds it extremely difficult to regulate eating.
Mood stabilizers did not work. We have started him on Concerta, with some trepidation, given our experience of a couple of years ago. This time we don't see the same negative side effects. It has helped him at school though has not helped the nastiness at home.
I don't at all think he is bipolar--he is just very inflexible, lives totally in the moment (can't plan ahead) and if something doesn't go the way he wants he reacts--nastily. I think it parts of the Fetal Alcohol Effects (FAE) thing which has definitely affected his executive functioning and his capacity for emotional regulation.
I am still looking for a way to successfully parent him---it seems to be getting more and more difficult. I get so tired of my words always getting twisted, of fights over whether he has to brush his teeth before TV every night--if I forget to mention it, we have major anger, of just the constant arguing. Most things have gone into basket C, but I have not succeeded in making any progress negotiating on basket B. I sometimes feel like I am living with an abusive spouse, and believe me if it were my spouse, I would be out of here.
It is just so hard to remain calm and detached all day long.
I am not sure any of this will help you. We have been searching for a psychiatrist with a deep expertise in Fetal Alcohol Syndrome (FAS) but haven't found one. I think that some of what might be called bipolar type behavior is actually brain damage of some sort that isn't easily medicated. There isn't of course any way to test for Fetal Alcohol Syndrome (FAS)--when children are young, however, the facial features can be measured and a presumptive diagonsis made.
Anyway, I would encourage you to ask your psychiatrist about a low dose trial (2.5 mg made a difference for us) of Abilify. It helped with focus and impulsivity both.
Sorry if I have not been very encouraging. I think I echo what others are saying --be sure you are not trying to treat a side effect of a medication with another medication. I would d/c current medication before going to a different one so that you are sure what you are dealing with.
Good luck.
P.