Friday, March 19, 2010

Medication: the Guessing Game

I know it would seem crazy to medicate a child so young, but once I learned about something called "the kindling effect", I really felt it was the right choice. Not only that, but our family was in crisis. Taz was miserable most of the time. I was stressed to the max. DH was having panic attacks in the middle of the night from all the stress, which is so absolutely not normal for him. I joke around that living with a child with bipolar causes everyone else in the house to have bipolar. It's like being on some kind of crazy ride you can't get off of. We were desperate to try medication. Of course we didn't really want our child to need medication. But it was clear he did. And the more we read about bipolar disorder, the more we knew that he needed it.

So. The kindling effect. I'm quoting from an online source because I can't really explain it any better.

"...initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independently of an outside stimulus), with greater and greater frequency. Thus, to put it simply, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. This theory has been borne out by some research observations. For example, "there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode..." thus taking the kindling analogy one step further: that a fire which has spread is harder to put out."

Scary, right? So, the longer someone goes without treatment, the harder that person may become in responding to future treatment. The most common medications used to treat bipolar disorder are anti-psychotics and mood stabilizers, which can be anti-seizure medications as well. Scientists aren't exactly sure why anti-seizure meds work, but there is a theory that bipolar episodes are a bit like having a seizure in the frontal cortex (the one effecting judgment) of the brain. Interesting. I wonder what will come of this theory.

Reading about the kindling effect was enough to scare me into seriously considering medication for Taz. Dr.S agreed. So the guessing game begins.

We started with a pretty common anti-psychotic called Risperdal. With medication you always start with a low dose then gradually increase it either until it works, or until it's reaching beyond a safe level for that person. If it still doesn't work, then it's not the right medication. The reason I call medication trials a guessing game is because every person responds differently to every medication. And no one really knows why or how. So the psychiatrist literally has to guess about which one to try and when. Of course, there are basic guidelines to go off of, but mostly it takes lots of trial and error.

Immediately we noticed that upon taking the risperdal, Taz's sleeping got worse. Dr.S wanted to keep it during the day because risperdal has been known to work well in young children to treat rages and aggression, two of our main issues. So he also prescribed a very very small dose of Seroquel, also an anti-psychotic, to be taken right before bedtime. Hallelujah! This was our savior for sleep. Right when we started the seroquel, Taz started going to bed on time and sleeping through the night. No more night terrors! I was thrilled. Everyone in the house was finally sleeping!

We eventually upped the dose of risperdal to 3 times a day to see if we could tame the rages and aggression. We are still on the risperdal but it wasn't enough. It works great to treat the mania. I can always tell when we are late or missed a dose because Taz gets that look in his eye I described before. DH and I look at each other practically reading minds. Did he get his medicine?

But risperdal doesn't do enough for Taz to stop the rages, aggression, irritability, and depression. I was hesitant to start a mood stabilizer, the most popular and well-known being lithium, because the side effect can be more serious and you need to be having regular blood draws, a traumatic experience for all of us. But I discussed it with Dr.S and he thought we should try Depakote. Now all these med changes happened within the course of several months, not weeks or days. I don't want you to get that idea.

Depakote is a seizure med that has been around for a while and has also been used for young children. We do have to get blood work every few months, but we're hoping the benefits are worth it. It's still pretty new for us but so far, so good. Taz has had a wonderful week. I'm hesitant to say it's from the med combo right now because, even though one may have a mental illness, they can still have some wonderful and stable times. We are hopeful but also guarded watching Taz do so well.

When I went into the medication world, I said to myself, one medication at a time, maybe two at the most. I would not be one of those parents who keep adding medication upon medication until I create the "perfect child". Of course no one on this journey is expecting perfection. We are expecting stability. It's completely different in ways I can't really describe, but parents of bipolar kids out there know what I'm talking about. Now Taz is on three medications. Do I wish it was two? Yes. Do I wish it was none? Yes. Do I wish I don't even have to be writing this? Yes!

The plan started that if the depakote works, we would taper down the risperdal so that he would only be on two medications. But if the depakote works, like it seems to be now, I will be so scared to change anything for fear of destroying our stability. I guess we'll cross that bridge when we get there.

Next post I'm going to list some common myths about medication. All my experienced bipolar battlers please chime in!


  1. I have to say, I have seen meds work WONDERS on kids. I worked with one child who would lose his ability to control himself if he missed a dose. He'd start acting out, we'd realize he missed a dose of his meds, and he would refuse to interact with his friends. He would say "I just can't control myself and I don't want my friends to see me like this!" The medication helped him feel better about himself, it gave him confidence to go out and be social, without worrying that his behaviors would have a negative impact on his ability to make friends.

    It sucks to be a child and feel like you can't control yourself. Meds gave him an opportunity to be his true self.

  2. Hi there and thanks for visiting my blog, you are more than welcome to post a link to it on your page. I'd appreciate it so very much! like you, I want to share information about children with bipolar and what the families live with day to day. your statement " living with a child with bipolar causes everyone else in the house to have bipolar" - is so right on the dot. I totally agree - we are all on such a ride determined by our child's mood and cycle. I hope you can find some stability in your home and some normalcy for your son.