I have a feeling this is going to be a page where the list grows over time because schizophrenia spectrum disorders are managed and brought into “remission” largely through pharmaceutical interventions. I thought it would be interesting to keep track of the medications that Grace is prescribed and their effect on her brain and disorder. They are listed in order of use.
Sertraline (Zoloft): formerly 75 mg/discontinued This drug was never a good idea because it’s an SSRI, and SSRIs tend to exacerbate cycling in the bipolar brain. If a psychiatrist is looking for a definitive diagnosis, however, then, by all means, prescribe an SSRI for a suspected bipolar child and watch them. If they are suddenly thrust into a mixed state or begin switching, then you’ve got your diagnosis. You have a bipolar child. This is exactly what happened to Grace. She actually ended up in the hospital.
2. Gabapentin (Neurontin): formerly 900 mg, reduced to 300 mg, increased to 600 mg, increased again to 900 mg This is an anticonvulsant drug that is used sometimes as a mood stabilizer, but it’s not effective. Most psychiatrists will tell you that. It is mildly effective for anxiety, but it doesn’t do anything for the bipolar brain. It does, however, have few side effects, and it has a short half-life in the body and requires no blood draws for checking levels. If you have Restless Leg Syndrome like Grace, then it’s mightily effective in treating that at 300-400 mg/day. Just don’t use it for treating Bipolar Disorder. It does, however, work wonders for neuropathic pain. ** Grace’s dose was increased to 600 mg to treat an increasing anxiety problem, possible seizure disorder, headaches, and Restless Leg Syndrome. If this works, we will have effectively treated four issues with one drug. That’s truly a wonderful thing when it happens. ** Grace’s dose was yet again increased back to 900 mg in order to prevent migraine headaches. She is back at her starting dose!
Lamatrogine (Lamictal): 200 mg/discontinued. This is an anticonvulsant drug that does not require blood draws to check for levels like some other drugs. It does have some side effects that must be watched for (a rash and THE RASH), but those can be avoided with a very slow titration. The thing that is good about this drug is that it is excellent at treating the depression in Bipolar Disorder without the use of an SSRI. It’s fairly effective quickly, too, even though it can take up to three months to reach efficacy due to the slow titration rates. In mid-November 2012, Grace’s treating psychiatrist in a partial hospitalization program bumped her dose from 100 mg to 150 mg overnight because her mood was still very unstable. Essentially, she was stuck in a psychotic state and manic at the same time. The increase made a difference. Even she noticed. As of October 2012, Grace’s primary side effects have been body aches. I have a fondness for the website Crazy Meds. They describe this particular side effect rather well:
Muscle aches, everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it.
As of February 2013, Grace will be discontinuing Lamictal because it just wasn’t effective for her. This drug takes about 2 weeks to taper because of THE RASH.
4. Melatonin: 10 mg Grace struggles with sleep. It seems to run in our family. Part of the issue is due to her Restless Leg/Limb Syndrome. When she’s depressed, she experiences insomnia. So, she takes melatonin as a sleep aid. It helps. One caveat: Melatonin can cause migraines if one is prone to them. I use melatonin to manage cluster headaches per my neurologist’s instructions, and my youngest daughter uses it for sleep onset. Something also to consider: Many psychiatrists will prescribe antihistamine-based sleep medications to aid in sleep for their soporific effects (Benardryl is an OTC antihistamine). Antihistamines exacerbate Restless Leg/Limb Syndrome! So, if you have RLS or if someone you know has it AND they are using an antihistamine to attempt to sleep better, stop immediately. Also, stop using antihistamines for your allergies, too, and consult an allergist. There are other options.
5. Aripiprazole (Abilify): 15 mg This is a third generation neuroleptic drug that took 26 years to develop and bring to the American market. Grace has been given this drug to treat her psychotic symptoms including visual and auditory hallucinations, paranoia, and delusions. This drug is also used as an add-on to treat depression with psychotic features as well as Bipolar Disorder. It’s got other uses as well. Grace was very ill the first day–extreme nausea and fatigue. It’s hard to get her to eat at this time, and I suspect that might be the reason for the extreme nausea although this drug does have a lot of GI side effects. Her GI side effects faded after a week, and her psychotic symptoms improved once the dose was increased from 5 mg to 10 mg. There are some other odd side effects like The Abilify Burp and The Hiccups of Death, but I think the strangest one of all is Rabbit Syndrome. Yeah…Rabbit Syndrome. It’s really a thing. For more information on Abilify, check it out: Crazy Meds.
6. Seroquel (quetiapine fumarate): 25-50 mg PRN Grace was given this drug to use as needed for psychosis. A few times a month Grace has a mini-psychotic break, and the only way to reset her is to induce sleep. After she wakes up, she’s stable. Since Seroquel is known to be quite sedating as well as used for schizophrenia, her doctor figured it might be worth a try. I haven’t used it yet. I’ll let you know what happens when we do. Addendum: I used it after she tried to harm herself. She was practically catatonic as in drooling and immovable. She was slurring her words. Come on, man! Isn’t there anything out there that’s better than this?!** This drug has been a lifesaver for Grace. She takes 50 mg at the onset of a mixed state or a mood that will spiral out of control. I take back everything I said about this drug. Grace loves it. It is necessary. Of course, the day is gone when she takes it. It’s worth it.
7. Lithium (lithium carbonate): 300-600 mg Lithium has such a bad boy rep, doesn’t it? It’s got street cred. Dr. Klerpachik and Dr. Whiskey consulted, and Dr. Whiskey told me to do some research on Lithium and Depakote so that I would be well-informed on both drugs, their effectiveness, and side effects. We decided to go with Lithium. It’s more effective in treating depression and suicidal ideation than Depakote, and it’s very well-studied in pediatric populations. Lamictal just wasn’t cutting it. Of course, when you start reading the Crazy Meds boards, Lithium starts to sound like the nastiest monster on the planet. I’m terrified to put it into my daughter’s little body, but I’m terrified to do nothing more. **After using Lithium at 300 mg for three months, Grace’s psychotic symptoms are greatly improved although she now has the infamous Lithium Tremor.
8. Topamax (topirimate): 100 mg, increased to 150 mg This drug is used to prevent migraines. It is an anticonvulsant at higher doses. At lower doses it can be used to treat PTSD, anxiety disorders, and even stabilize moods. This is a drug I know quite well; I take this one for migraine prevention. There are two side effects that I experience–drug-induced anorexia and cognitive blunting. I am rarely hungry, and I’ve become the Village Idiot. The longer that you’re on the drug the better the cognitive slowing becomes. It’s either that or I’ve simply become accustomed to being stupid. I regularly lose my car in parking lots now. I’ve forgotten my PIN twice and had to get a new one. I randomly lose things. I forget words mid-sentence. I forget driving directions and get lost. This is all Topamax at work. It slows down the brain being an anticonvulsant. It does, however, really help with migraines. It has worked wonders with Grace’s migraines. She rarely gets them now. The dose was increased because Grace began getting atypical migraines. They stopped after the dose increase.
9. Toradol injections: PRN These are used at the onset of a migraine to stop the migraine. So far, they have been very effective.