Posted by SLS on August 18, 2006, at 23:26:14
In reply to Re: Please help... Bi-Polar Son... » SLS, posted by justscared on August 18, 2006, at 8:35:52
Linkadge makes some very good points regarding the use of lithium. I think you should discuss with the doctor what place he feels it has in your child's treatment.
Everyone wishes they had a crystal ball. Biological psychiatry is still in its infancy, and much of its treatments still requires trial-and-error.
I don't know what to say about the Zoloft. I think this is another area where you have to question the doctor as to what was his rationale for making his treatment decision. In adults, Zoloft can be an effective treatment for pathological aggression. However, in children and adolescents, it can have the reverse effect and actually produce aggression. Perhaps this has all been taken into consideration. One thing I read on pediatric bipolar disorder advised discontinuing SSRIs immediately upon proper diagnosis. I think you are going to encounter differences of opinion regarding the use of antidepressants in this situation. I don't like to second-guess doctors, though.
It seems to me that some of the better-known doctors are using a combination of lithium and Depakote to start with and adding an atypical antipsychotic if there is an urgent need for a response or an ultimate non-response to the combination treatment.
Lithium is being looked at for treating aggression and conduct disorder in children and adolescents. It would make a neat little package to use it as monotherapy to treat everything as Linkadge suggests. Perhaps you can sit down with the doctor and develop a treatment algorithm together. Maybe you would prefer to start with lithium instead of Depakote. Of course, we don't know the doctor's rationale for choosing this drug yet. The problem with trying one mood stabilizer at a time is that one must allow each drug weeks or months to work.
The advantage to using an antipsychotic is that it is supposed to work fast. I don't know how much time it makes sense to invest in Risperdal if it is not helping. Ask the doctor where he is headed with the dosage and whether or not he feels it must be combined with a mood stabilizer to be evaluated properly. If the answer is yes, then you are pretty much committed to remaining on Risperdal until you reach therapeutic levels of lithium and/or Depakote for an adequate trial period.
I hope you are not more confused and upset now than when you started.
1. Why Zoloft?
2. Why Depakote and not lithium?
3. Combination of Depakote + lithium?
4. What maximum dosage of Risperdal?
5. How long is an adequate trial for each?
- Scott
poster:SLS
thread:677083
URL: http://www.dr-bob.org/babble/20060818/msgs/678000.html