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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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Dr. Vikas only: OKMH63211

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Dr. Vikas only: Dear Doctor, I am so happy to be able to get back in touch with you. You and I seem to be on the same page as far as safety factors and effectiveness of meds for my 7 year old. A few things have happened since we last were in touch. Seraquol did not fit well with her. I have her on Abilify 2mg which completely transformed her. She is still difficult and stubborn but no longer impossible, rageful, violent and out of control. Nice, nice, nice! You were right that as soon as I got her mood under control, she no longer needed the Ritalin. Right on Doc! I took her to the children's hospital in town for a long awaited session with one of their pyschiatists. She said Abilify can do internal damage over the long run with my kid and that the antipsychotic meds are less safe than putting her on something like Lamictal and Lithium. She was definitely diagnosed with a mood disorder. Doctor said her aggression, violating others personal space, insatiability and irritability were because of the mood disorder. She also thought my child was paranoid due to being afraid of monsters in our home at night in the dark at age 7. Also, my kid would freak out before being on Abilify if she thought I looked at her wrong or did not accept the tone of my voice. I do not know if I agree that my kid is paranoid. She does not hear voices or think people are watching her or following her. My kid is doing great in school academically and is very sharp and astute. Well, the doctor today said she should be on Lamictal and Lithium at the same time. She thinks the two meds work well together because they help different receptors in the brain. I asked her why she diagnosed my kid having a mood disorder and the response was due to family history, switching moods, other doctors' previous notes on her and the agitation. These meds scare me but the doctor said that they are not as harmful in the long run as Abilify. She has seen Abilify most likely cause either liver damage or kidney damage. Also, she did say that the Lamictal and Lithium can cause organ damage as well in the long run. Yikes! She also wanted to keep my kid on the Abilify until the Lamital and Lithuim kicked in. What should I do? I do not want to hurt my precious daughter? please share your invaluable thoughts. Below is a recap of what we last spoke about: Dear Dr. Vikas My child has rapid cycling of moods and is defiant to the max. She has no friends and is so irritable and gets agitated easily. She explodes and is anti social and does not listen to any rules and crosses peoples personal spacial boundries and does not read social cues. On the other hand sha is so sharp and bright and alert. Can be very sweet and caring and remorseful. She maintains great eye contact and is very aware and astute. She is in the top of her class academically. This is definately some kind of conduct issue! Would you share your advice on several possible medications for my child? I am concerned about her safety and want to confirm with you before putting my 7 year old on anything that could potentially harm her. We are still struggling with after years of trying Risperdone, Geodon, Paxil, Prozac. Risperdone worked buy could not tolerate side effects. Geodon helped a touch but eyes began to roll back to the head after 8 months. Paxil and Prozac were disasters. Yesterday we all met with Dr. a board-certified doctor of child and adolescent psychiatry. He diagnosed her as having a mood disorder and inattentiveness. (She displayed her defiant behavior and showed true signs of agitation, frustration and restlessness—to the max.) He recommended putting her on 5mg of short acting Ritalin (3x/day) and temporality putting her on 25mg of Seroquel at 4pm to balance out the moods and complement the side effects of Ritalin. I was concerned with what I read about Seroquel and the short term safety of it for a seven year old. Even though she does not have bipolar,it is not approved to treat bipolar depression or for maintenance treatment of bipolar disorder in individuals under the age of 18. My child would be prescribed this for the purpose of a mood disorder. Dr. also plans on taking her off the Seroquel in June (when school is over) due to long term risks and possibly putting her on (maybe) Lithium or Depakote for more long term treatment. He just did not want to aggravate the remainder of her school year with the medication adjustments of those formulas and wants to wait until June to begin. I’d appreciate knowing your opinion on the safety and effectiveness of Seroquel and either Lithium or Depakote in a 7 year old---and for the purpose of a mood disorder? She would remain on the Ritalin. I am concerned with Lithium affects and slowing down her metabolism as well.

Submitted: 1 year ago.
Category: Mental Health
Expert:  Camille-Mod replied 1 year ago.

Hi, I'm Camille and I am a Moderator for this topic. I sent your requested professional a message to follow up with you here, when they are back online.

If I can help further, please let me know. Thank you for your continued patience.

Expert:  Dr. Vikas replied 1 year ago.


Hello,

Thanks for the follow up and telling me about her condition.

I am really very happy to know that she is now improving and responding well to her medicines. This is indeed a very good news :)

Now regarding her medicines, Lithium and Lamotrigine are indeed a good choice for Bipolar disorder but I personally don't use Lithium frequently in children because younger children tend to have more frequent side effects and should be monitored more frequently while on Lithium.

Lamotrigine is also a good choice as a mood stabilizer but it is used in children primarily for Lennox-Gastaut syndrome which is a seizure disorder. Using it as an mood stabilizer in children will be an off-label use. It is not known if LAMICTAL is safe or effective in children or teenagers under the age of 18 with mood disorders such as bipolar disorder or depression.

Regarding the use of Abilify in children -

"Abilify was recently approved for the acute treatment of manic and mixed episodes associated with Bipolar I Disorder with or without psychotic features in pediatric patients (aged 10-17), in February 2008.

The FDA approval was specifically for maintenance treatment of manic or mixed episodes, and as add-on treatment to lithium or valproate, for children ages 10 to 17 who have Bipolar I Disorder, the more severe type of bipolar disorder. "

source


As your daughter is responding well to a very low dose of this medicine therefore in my view continuing Abilify could be a better option instead of shifting her on Lithium and Lamotrigine. If her doctor think that she is paranoid, in that case again an atypical antipsychotic like Abilify will be a better option than Lamotrigine or Lithium because Lithium or Lamotrigine are not useful for treating paranoid symptoms.

If required, the dose of Abilify can be increased later by her doctor.

In case of worsening of her symptoms, a combination of Aripiprazole with Lamotrigine if required at all will by my first choice instead of combining Lithium with Lamotrigine.

Having said this, her doctor is the best judge here regarding medicines as he or she exactly knows about her clinical condition but still in my view, You should discuss with her doctor about these options mentioned below also before shifting her on Lithium and Lamotrigine

- further increasing the dose of Abilify

- using combination of abilify with Lamotrigine if required at all.



Kind regards

Vikas
Customer: replied 1 year ago.

Namaste,


 


Please share with me in your opinion what paranoia is and if what my daughter's experience is anything like that.


 


Also, my kid would freak out before being on Abilify if she thought I looked at her wrong or did not accept the tone of my voice. I do not know if I agree that my kid is paranoid. She does not hear voices or think people are watching her or following her. My kid is doing great in school academically and is very sharp and astute.


 


She also thought my child was paranoid due to being afraid of monsters in our home at night in the dark at age 7.


 


She said Abilify can do internal damage over the long run with my kid and that the antipsychotic meds are less safe than putting her on something like Lamictal and Lithium.


 


I also need your opinion of the long term safety of being on a atypical anti psychotic med such as Abilify.


 


The doctor we saw has seen Abilify most likely cause either liver damage or kidney damage.


 


Also, she did say that the Lamictal can cause organ damage as well in the long run. Yikes!


 


Overall, that doctor thought Abilify is highly dangerous for longterm use. Especially on the organs and producing permanent muscle and tic issues.


 


Please clarify.


 


My preference is to avoid the Lamictal if possible. My kis is now finctional on Abilify but it is her safety I am concerned about.


 


Thank you so much!

Expert:  Dr. Vikas replied 1 year ago.
Namaste :),

Paranoia as a word is sometimes used for paranoid symptoms like the one you have mentioned. The other term used is Paranoid delusions.

"Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself. (e.g. "Everyone is out to get me.") Making false accusations and the general distrust of others also frequently accompany paranoia. "

source : http://en.wikipedia.org/wiki/Paranoia

A paranoid patient may or may not hear voices (Auditory hallucinations).


"

She also thought my child was paranoid due to being afraid of monsters in our home at night in the dark at age 7." - I agree with you here that simply on the basis of this statement it can't be said that she is paranoid. I guess, you need to discuss with her doctor in detail about this point.

 

All medicines can produce side effects and these side effects can vary from patients to patients. It depends on the personal experience and the choice of a particular doctor which medicine he or she consider safe in his or her patients.

 

In my view, Lithium has the maximum serious side effects in comparison to Aripiprazole and Lamotrigine.

 

I don't know, why her doctor said that Aripiprazole is " highly dangerous for longterm use." It could be because of her personal experience with this medicine.

 

It is really difficult to predict, how a medicine will affect the patient when used for long duration and this also varies from patients to patients. For mood disorder, treatment is typically continued for a duration or 1-2 years in case of single episode and then the medicines are tapered down and stopped. I don't think that Aripiprazole can cause significant organ damage when used for 1-2 years.

 

 

 

 

Customer: replied 1 year ago.

Wow doctor! She maybe possibly only need this for 1-2 years?


 


So when someone has a mood disorder or a bipolar diagnosis it is not necessarily for life that they need to medicate?


 


Why is that since the brain is not being fixed only medicated to cope? Unless I am wrong. Please tell me about that.


 


My kid acts crazy with out the Aripiprazole and totally calm and manageable with it.


 


Is the Aripiprazole prescribed for mood disorder often? i wonder why it is helping my kid so much!


 


Mother's instinct tells me my kid is just a kid not with paranoid thoughts.


 


May I write to you on a separate question to get some help on my own brain issues?


 


;-))

Expert:  Dr. Vikas replied 1 year ago.

For Bipolar disorder, specially in cases of single episode, the treatment duration is only of 1-2 years. It is not necessary to take life long medication for Bipolar disorder.

Aripiprazole is also a very good mood stabilizer besides being an atypical antipsychotic and is often used as an mood stabilizer.

It does not matter much whether or not she has paranoid thoughts in her case right now because the treatment part will still the same. You need not to worry about it much.

Yes, definitely, you can ask your question in a different thread after closing this one. I would be more than happy to answer, if I can.

Kind regards

Vikas
Customer: replied 1 year ago.

Lastly,


 


For Bipolar disorder, specially in cases of single episode



What does single episode mean in this case?

Expert:  Dr. Vikas replied 1 year ago.

See, a patient suffering from Bipolar disorder may suffer from manic episode / period, depressive episode, hypomanic episodes during their life time with a normal period in between.

These episodes may last several weeks or months or may be longer in certain patients.

For example, right now, your daughter is suffering from manic episode.


Bipolar affective disorder (manic depression): information for parents, carers and anyone who works with young people
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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