med change--opinions?

[Parents! Get help here!]

My dd17 has been on Prozac for over a year, and on Lamictal since she was diagnosed in June. She also takes Trazadone for sleep (which doesn't always work), and Ativan as needed for panic attacks (once or twice a week on average). She takes Vyvanse for concentrating in school, but not on weekends. And BC pills.

This seems like a lot of drugs to me. We are interviewing new psychiatrists because the current one doesn't seem to listen to her and has become somewhat of an anxiety trigger in and of himself. We talked yesterday to one who spent about an hour with us (quite a bit of it talking to my daughter one on one without me there, at my request). She's recommending staying on the Prozac, adding 50 mg of Seroquel at night, and dropping the Trazadone and possibly the Lamictal. She also says that if we get the daily meds right, dd shouldn't need the Ativan and we might be able to drop that, too. (The idea of not having a PRN for panic seems to induce panic, unfortunately, so we may need to maintain a scrip as a security blanket for awhile.)

This doc thinks we ought to have a full neuropsych eval to see if dd truly has ADHD and needs the Vyvanse. DD says it helps her concentrate but sometimes leaves her with the jitters.

If we could whittle from six drugs to three, that would be awesome. Does anyone have any experience with this combo, especially compared with other regimens? I know everyone's different, but thought I'd ask anyway.

[inkling16]

My dd17 has been on Prozac for over a year, and on Lamictal since she was diagnosed in June. She also takes Trazadone for sleep (which doesn't always work), and Ativan as needed for panic attacks (once or twice a week on average). She takes Vyvanse for concentrating in school, but not on weekends. And BC pills.

This seems like a lot of drugs to me. We are interviewing new psychiatrists because the current one doesn't seem to listen to her and has become somewhat of an anxiety trigger in and of himself. We talked yesterday to one who spent about an hour with us (quite a bit of it talking to my daughter one on one without me there, at my request). She's recommending staying on the Prozac, adding 50 mg of Seroquel at night, and dropping the Trazadone and possibly the Lamictal. She also says that if we get the daily meds right, dd shouldn't need the Ativan and we might be able to drop that, too. (The idea of not having a PRN for panic seems to induce panic, unfortunately, so we may need to maintain a scrip as a security blanket for awhile.)

This doc thinks we ought to have a full neuropsych eval to see if dd truly has ADHD and needs the Vyvanse. DD says it helps her concentrate but sometimes leaves her with the jitters.

If we could whittle from six drugs to three, that would be awesome. Does anyone have any experience with this combo, especially compared with other regimens? I know everyone's different, but thought I'd ask anyway.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[cfh]

inkling16

My ds29 has been on as many as 8 rx's at once.  I always felt that this seemed wrong but the pdocs kept giving him more.

I think the idea of a full neuropsych eval is a great one.  My ds T recommended we have it done about 3 years ago because he felt that there might be some brain impairment in addition to all the other diagnosis.

It was expensive and insurance did not cover but the evaluation showed that he had impairment to his frontal lobe and that he was probably born with it.  We adopted our ds at birth and his bio mom did lots of drugs and drinking while pregnant.

It explained so much and it would have been great to have that info when he was young but at least we have it now.

[jellibeans]

I have been thinking a lot about this topic recently... .  my dd is on 30mg prozac and 200 lamictal... .  she has trazadone but rarely takes it for sleep... .  she is on ritalin 30mg... .  right now I think this combo is helping but I am not sure any of it is rally helping her.

I had a one on one with her T today and she suggested a new neuropsych evaluation... .  she had one two years ago but she said that was before our more recent problems with her. the last year has been a real roller coaster so I will look into it again for this summer.

I think it is a really good question you have brought up... .  i think about the drugs a lot and we have had some major changes in drugs over the past three months and it has been like a living hell at my home to wean her off one and get her on another... .  a long and process and it is more easy done while they are in a hospital setting I think or RTC... .  the drugs I think does make a difference but I don't think they are the real answer... .  

[jbmom]

We are in the process of streamlining DD's meds. She's on very close to the same minus prozac. She take Trileptal, Trazodone, Concerta, Naltrexone & Depo provera  Our issue is DD is so immature she can't really talk about how she is doing on meds. She doesn't want to take them, complains about the number but complains about stopping them.

So the eval of efficacy really only comes from our opinion which is not complete (I haven't learned to read her mind yet).

Keep us posed how it goes.

[griz]

inkling16:  My daughter was on lexapro and they added Seroquel in the evening.  Although she took the Seroquel in the evening after about 2 weeks I had her teachers calling me to tell me that DD was falling asleep in class.  I found while on the Seroquel she could sleep not only at night but if she was home she could sleep for most of the day also.  We also found even when she was on the lowest dose (however she was on Seroquel XR) that she would sometimes pass out if she stood up to quickly.  This happened a number of times in school.

Not everyone reacts the same so I would just ask the P about it.

Griz

[sunshineplease]

My ud17 has been on Zoloft, Lexapro, Prozac, Seroquel, Cymbalta, and Trazadone, in some combination or other, for a year. None have done anything to help, and several caused side-effects, from headaches and weight gain to non-period vaginal bleeding. So I've done a ton of research, and found there's some consensus that the effect meds have on BPD is "moderate" at best. Which makes sense, since BPD is a personality disorder and not a mood disorder. Med resistance is actually a diagnostic indictor sometimes. (Please note I understand there's lots of comorbidity and for some people there ARE mood issues!)

The other thing I read (in a book called Self-Harm Behavior and Eating Disorders) is that, for people with body image issues, the psychic drain that accompanies the weight gain associated with many of these medications can far outweigh the meds' benefits.

So we're taking our sweet daughter off everything, for now. We'll revisit medication if/when she's done more cognitive work and has shown the ability to 1) distinguish what's really helping from what she wishes would help, or is using as a crutch,  2) manage her own meds without engaging others (aka me) in "oh, my god, I'm out of XYZ and forgot to tell you I needed more" craziness,  3) is willing to be honest with the prescriber about the side effects that bother her.

I found this article of particular interest. It made me think Topamax might be a viable options for my daughter's particular symptoms. Except for the part about hair falling out. Oh, yeah, and suidical ideation... .  

www.BPDdemystified.com/treatments/medication/

[inkling16]

inkling16:  My daughter was on lexapro and they added Seroquel in the evening.  Although she took the Seroquel in the evening after about 2 weeks I had her teachers calling me to tell me that DD was falling asleep in class.  I found while on the Seroquel she could sleep not only at night but if she was home she could sleep for most of the day also.  We also found even when she was on the lowest dose (however she was on Seroquel XR) that she would sometimes pass out if she stood up to quickly.  This happened a number of times in school.

Not everyone reacts the same so I would just ask the P about it.

Griz

Ha! My daughter can sleep most of the day no matter what. They did mention that they'd do either 25 mg Seroquel or a 50 mg time-release version. If we do end up making this change, I anticipate a period of jiggering to get it right. This is great information about what to watch for.

Re the concerns of others, I agree that weight gain as a side-effect would be a deal-breaker, but the doc says it shouldn't be an issue with this low a dose. I'm in charge of administering the meds, so there's no issue at the moment with dd having to keep track of anything (and a good thing too, since it didn't work out well when we tried that), but I do fear for the day she leaves home (which could be anywhere from her 18th birthday to never) and would like to have her either off meds or on a simpler regimen by then.

We are talking to another P-doc in a few weeks and will make our decision then. The one we saw this week practices in the same organization as her pediatrician, and is supervised by my P-doc, so there would be a little more continuity of care than we've had previously. The second one practices in the same office as her DBT therapist and they see each other often, so there would be continuity there, too. I'm hopeful that if we can get one she's comfortable talking to, we can get the straight story on drug effects/side effects. This will be our fourth P-doc in three years. She hated the first and third one (the current one) and liked the second, but I think that was mainly because he said something that led her to believe that he thought there wasn't anything wrong with using weed for self-medication. So we're not going back to him, that's for sure. I'm not unilaterally opposed to weed, but in this context it's kind of like baking a batch of cupcakes for a diabetic.

I don't think these drugs are in any way a cure, but the current combo has been a vast improvement over her pre-medicated self, and I think they calm her mind enough so she can focus on therapy at least somewhat. And she's so much easier to live with.

[sunshineplease]

inkling16, "in this context it's kind of like baking a batch of cupcakes for a diabetic" made me laugh. Yes.

I'm so glad some of the meds are working for your daughter. And sounds as if you've got some good options for a new p-doc. Yay.

[MammaMia]

Seroquel made my BPDs EXTREMELY hostile.  Be sure you monitor it closely.