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Dear Dr. Vikas My child has rapid cycling of moods and is

Dear Dr. Vikas My child has...

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 affect and slowing down her metabolism as well.

Thank you so much!

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Answered in 13 minutes by:
5/10/2013
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
Dr Vikas :

Hello

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Hello Samantha,

Thanks for your question. I will get back to you after some time as I am a little bit busy right now.

Will try to get back to you within few hours.

Thanks

Vikas
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Customer reply replied 4 years ago
No problem doc. :-)
First of all, please accept my apologies for the delay in replying back.

Samantha, honestly speaking, her case is a bit complicated because of the dual diagnosis of ADHD (inattentiveness) with Bipolar disorder.

In my view, it is likely that her inattentiveness could be also because of Bipolar disorder but her psychiatrist must have evaluated her fully before making these two diagnosis.

Ritalin is a stimulant and can worsen mood symptoms but it is necessary in her case because of Inattentiveness. Now since she is on a stimulant therefore a mood stabilizer is also very necessary because Ritalin when given alone can destabilizer her mood further.

Most of the medicines used in Bipolar disorder are approved for children older 10 years of age or more but still can be tried in younger children by experts such as psychiatrist.

Seroquel (Quetiapine) is an effective mood stabilizer and can be useful in her case for the time being till her doctor shift her on Depakote. I personally, don't prefer Lithium because of side effects.

25 mg of Seroquel is a very low dose comparatively. It can be very sedative in some patients and your daughter may experience significant sedation with this medicine. Just discuss with her doctor about her taking it at night before sleeping instead of taking it in evening.

We have personally used Quetiapine (Seroquel) and Depakote in small children and most of them are able to tolerate it well so you need not to worry a lot about the side effects of these medicines in her case.

Please feel free to discuss further for any doubt or query you have regarding my suggestions.

Kind regards

Vikas
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Customer reply replied 4 years ago

Hello,

Her doctor said she does not have bipolar disorder. No mania or elation. She has a mood disorder that go from neutral to agitation and angry.

How long until the Seroquel shows some sign of positive change? With the formal Risperdone and Geodone I could see some improvement within 3-4 days. Day 2 on Seraquel I see nothing expect as you stated extreme sedation.

Is it true what her doc says about the Ritalin and Seroquel balancing each other out?

When I get her off the Seroquel in a few weeks, how is that done. Do you just stop a 25mg or does it need to be eased off and cut in half or something?

Please share some information on Depoke both plus and minus. I am going to avoid the Lithium as you said.

It is strange because she has had days or weeks or being somewhat normal and then switches. Her personality switches and defiance stand out. She hits when she us very mad.

Since child need to follow rules for safety and future growth and she goes against me or argues for most everything. So many meltdowns and whining about brushing teeth, doing homework, bathing eating healthly items , holding my hand crossing a street. It is almost like Aspergers but her awareness and eye contact are exceptional. Very bright child.

What else can you say about her?

Is there a way to keep her normal without these serious meds. Changing her diet has not helped much.

Any natural supplements that can help instead.

This child clearly has an inflexible brain.

Thanks Dr.

Samantha, Mood disorder is another name of Bipolar disorder.

In young children. Classic manic symptoms are uncommon in this age group although depressive symptoms may be evident. Early onset Bipolar disorder is characterized by extreme irritability, aggressive outburst and violent behavior. In between outburst, children may continue to be angry or dysphoric.

Characteristic symptoms in this age group include extreme mood variability, intermittent aggressive behavior, high levels of distractibility and poor attention span. These symptoms are fluctuating in nature.

Now regarding treatment part, various studies has shown that Depakote (Valproate) and Lithium are both effective in young children and it depends on the personal choice of treating doctor which medicine he or she like to choose.

According to some studies, Quetiapine (Seroquel) has also been found to be useful in children suffering from mood disorder. Currently she is on a very low dose of Seroquel and may be she will respond better once her doctor increase the dose of Seroquel further. Seroquel should not be stopped abruptly and needs to be taper down slowly.

You can also discuss with her doctor about trying Olanzapine which is also a atypical antipsychotic like Seroquel and a good mood stabilizer too.

She will be needing medicines to control her symptoms and there is no such natural supplements which can replace medicines.

I can understand your feelings and do appreciate your love and affection towards your daughter. At this stage, all she need is your love and affection.

There are chances that she will respond to Depakote well and once her mood symptoms are under control, her ADHD symptoms will also respond to medicines.
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
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Customer reply replied 4 years ago

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.

Ask Dr. Vikas Your Own Question
Dr. Vikas
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
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Experience: MBBS ; M.D Psychiatry, MS. Health Informatics

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