Expert: Joyce A. Anthony - 5/1/2008

Question
I have a 13 year old son that was diagnosed with ADHD when he was in the 2nd grade.  We tried several medications which all gave him severe tics and made him very withdrawn so we discontinued all meds.  He was on these meds until he was 9.  We continued having problems with him over the years but hoped he would mature or outgrow.  This year, we put him in a psychiatrict hospital and he was diagnosed with a mood disorder and leaning towards Bipolar Disorder.  We have been through 2 psychiatrists and several mood stabilizers and antidepressants.  He is now on 20 mg Zyprexa and 10 mg Celexa.  The last doc put him on 20mg Focalin XR for the ADHD but we have seen no improvements only the dreaded tics we experienced with the stimulant drugs in the past.  He is becoming more defiant and doesnt seem to care about a thing no matter what the outcome.  Sometimes I think the drugs are making things worse.  I talk to the doctors but they just experiment with other drugs and wonder what kind of damage they could be causing him in the long run.  I dare say he has had no mania episodes but has had long periods of depression.  Do you have any good advise for me--I feel there is so much info out there on this condition that I am drowning in it.  I am desperate for answers!!
Thank You


Answer
Hi Sandy:

It can be very overwhelming trying to navigate the mental health system, especially where children are concerned.  It sounds to me that your son is being treated solely for ADHD.  While this disorder often co-exists with bipolar disorder, it is necessary to get the bipolar stabilized first--and then decide if there is truly ADHD.  Many times bipolar disorder in children appears to be ADHD,

Rather than allow multiple changes in medication, I will suggest you go in with your own suggestion.  The past few years, there has been a great deal of success with treating bipolar children with a combination of Seroquel and Lamictal.  Ask your current psychiatrist what he/she feels about trying this combination.

These two drugs are fairly new on the scene but they appear to be working where more traditional treatments fail.  Many children are being brought too low concerning mood with other medications.  That seems to be what is happening with your son.

It may take a bit longer to notice results with the Lamictal because it needs to be started low and increased slowly.  There are, however, very few side effects with this medication so it is worth the wait.

I hope this has helped clear the confusion somewhat.

                   Joyce A. Anthony