Bipolar Meds question

[MicheleB]

My almost 16yo dd was dx with bipolar disorder when she was 11. Currently, she is taking 20 mg of Prozac, 100 mg of Lamictal and Risperdal (I think it's the smallest dose, doubled) daily.

She is SO tired. She has told me for a long time she's so tired. But I don't know what else I can do. I am sure it's from her meds. But 1) I just hate to mess with meds that are controlling her moods and 2) is there really a way to get around tiredness with all those meds anyway?

I know how she feels. I have bipolar disorder and I feel like I have to drag myself through most of my days.

What have you done for your kids with bipolar? Is the fatigue inevitable? Could she maybe cut back on the Lamictal? She just started the Risperdal because she was having paranoia, and this current dose has really helped. She's been on Prozac and Lamictal for several years.

Currently, her general doctor is monitoring her meds because we have one psychiatrist in this town, and it is almost impossible to get in to see him.

Her main symptom is mania... she talks a lot, gets very silly and hyper. She gets depressed on occasion... maybe twice a year for a week or so, but that doesn't seem to be her main issue. Plus the paranoia... feeling like people are talking about her or watching her.

Any thoughts? She will be seeing a neuropsychologist for an evaluation sometime this winter, so perhaps he'd be willing to prescribe for her.??

[Ottakee]

If mania is her main symptom, why is she on Prozac which is an anti-depressant? or was she very depressed but the Prozac is taking care of that?

100mg of Lamictal is quite low for a 16 year old. Have you had any blood levels done? It could be that she needs MORE of that. You need to do the blood tests 12 hours after her last dose and before the next one. My 12dd is on 50mg twice a day while my 14dd is on 325mg twice a day--so the dosage can vary widely.

Risperdal can cause sedation but has this been a problem before the Risperdal? Risperdal has been WONDERFUL here for psychosis---haven't had any since starting it 9 years ago.

A neuropsychologist won't be able to prescribe meds as they are not a medical doctor.

Can you drive to a larger town to see a pediatric psychiatrist? We have followed our pdoc to 5 different towns in the area just to keep her.

Has your daughter had her thyroid, blood sugars, iron level, etc. checked as well? Thyroid issues can often go with bipolar but need thyroid meds.

I don't think that you have to put up with the fatigue. I know that we don't here and my dd is on thyroid meds, 3 seizure meds (also used for bipolar), Risperdal, Dexedrine (stimulant), and meds for her mitochondrial disorder.

[asta]

My almost 16yo dd was dx with bipolar disorder when she was 11. Currently, she is taking 20 mg of Prozac, 100 mg of Lamictal and Risperdal (I think it's the smallest dose, doubled) daily.

She is SO tired. She has told me for a long time she's so tired. But I don't know what else I can do. I am sure it's from her meds. But 1) I just hate to mess with meds that are controlling her moods and 2) is there really a way to get around tiredness with all those meds anyway?

I know how she feels. I have bipolar disorder and I feel like I have to drag myself through most of my days.

What have you done for your kids with bipolar? Is the fatigue inevitable? Could she maybe cut back on the Lamictal? She just started the Risperdal because she was having paranoia, and this current dose has really helped. She's been on Prozac and Lamictal for several years.

Currently, her general doctor is monitoring her meds because we have one psychiatrist in this town, and it is almost impossible to get in to see him.

Her main symptom is mania... she talks a lot, gets very silly and hyper. She gets depressed on occasion... maybe twice a year for a week or so, but that doesn't seem to be her main issue. Plus the paranoia... feeling like people are talking about her or watching her.

Any thoughts? She will be seeing a neuropsychologist for an evaluation sometime this winter, so perhaps he'd be willing to prescribe for her.??

Tiredness (in general) can sometimes be ameliorated by taking all of a daily dosing at night.

Lamictal is not a first line med for mania, though for some folks it does work. Ottakee is right about having a serum level checked. (It is easiest to do it first thing in the morning prior to taking the morning dose.)

Many, many BP folks have manic reactions to antidepressants. Dr. Phelps has a big thing on his site about this (just google him). It is possible that the LTG is trying to counteract the Prozac and isn't able to, thus allowing the paranoia (which, as you know is creeping psychosis) to slip in, thus necessitating the addition of Risperdal.

I'd second the search for a pediatric Pdoc. Kids react SO differently to meds than do adults, it really is worth even a day's drive to get the right med cocktail.


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[MicheleB]

Thank you!

That is very interesting info about the Prozac and possibly resulting symptoms.

She was very depressed when she went into the hospital at age 11, and then dx with BP. I do feel the Prozac keeps that controlled.

Her doctor won't do serum levels for Lamictal because she said that is more for people taking it for seizures.

She was tired *before* the Risperdal and she really notices that the Risperdal helps her.

I will look to see if I can find anyone we can take her to... Ped. Psych.

Thank you again. :)

[MaMa2005]

You might want to look into finding a psychiatrist that also is trained in pharmacology. I've had BP for 10 years now and when my first psychiatrist (who was also trained in pharmacology) moved to NY, he recommended that I should always have a psych/pharm doctor for meds.

I use another person for my therapy and he works in conjunction with my psychiatrist if needed to make sure all my meds work approriately.

[Ottakee]

Check out http://www.bpkids.org/site/DocServer/treatment_guidelines.pdf This is about 5 years old and doesn't hold Lamictal in a good light---but current research shows that is is safe and effective if dosed/titrated properly.

This should give you a bit of insight on the various meds, combos, etc. to figure out what might be needed for your dd. Obviously a top notch pdoc should make the med changes but this way you will know more about the various meds, med classes, side effects, combos, etc.

Prozac is well known for increasing mania in kids with bipolar. Lamictal is very helpful for depression but not quite as strong on mania----but Risperdal is very good for mania.

Can you get the doctor to humor you and get the blood test? Our pdoc is the one that started it and our neurologist also monitors the Lamictal level.

It could be that Lamictal at the right dose along with the Risperdal would be enough for your dd. Risperdal can have serious side effects but watched closely, it can be a wonderful med. I keep saying that I LOVE RISPERDAL as it has worked so well here.

[Night Elf]

I have BP as well. My doctors told me that meds need to be monitored to change them as needed. My manic episodes were my biggest problem when I was first diagnosed with BP and the Lamictal is helping my balance. My meds are still being changed every couple of months to find the right balance though. I've not taken Risperdal, but am taking Lamictal, and sleeping aids, Trazodone and Ambien. I too have a therapist in addition to my psychiatrist. Are you certain that her GP can keep the combination of meds appropriate for her body? My GP had put me on the Prozac but my psych took me off because she said it wasn't necessary for the problems I was having.

Is there any way you can find a psych to see her? If you called the one in your town, could you tell them your dd is having a problem with the combination of meds and you aren't sure what to do?

My blood panel is monitored for my Lamictal.